Citation Nr: 0726904 Decision Date: 08/28/07 Archive Date: 09/04/07 DOCKET NO. 98-20 101 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in Reno, Nevada THE ISSUE Entitlement to service connection for dermatofibrosarcoma protuberans (DFSP) of the chest. REPRESENTATION Appellant represented by: Louis M. DiDonato, Attorney WITNESS AT HEARINGS ON APPEAL Appellant ATTORNEY FOR THE BOARD Nancy S. Kettelle, Counsel INTRODUCTION The veteran had active service from March 1965 to May 1968. This matter came to the Board of Veterans' Appeals (Board) on appeal from decisions of the Department of Veterans Affairs (VA) Regional Office (RO) in Reno, Nevada. The veteran testified before a hearing officer at a hearing held at the RO in February 1999, and he testified before the undersigned veterans law judge at a hearing held at the RO in November 2000. The Board remanded the case for additional development in February 2001, March 2003, and November 2006. As was noted by the Board in its February 2001 remand, the RO initially styled the issue as whether new and material evidence has been submitted to reopen a claim of service connection for DFSP. The Board pointed out that during the pendency of the appeal, there had been a regulatory change in 38 C.F.R. § 3.311 effectively including DFSP as a radiogenic disease for purposes of that regulation. In view of the liberalizing nature of the regulatory change pertinent to the claim for DFSP based on exposure to ionizing radiation, which in effect created a new basis of entitlement, the veteran's claim has been reviewed on a de novo basis. See Spencer v. Brown, 4 Vet. App. 283 (1993). FINDINGS OF FACT 1. The veteran was not a participant in U.S. atmospheric nuclear testing, and the evidence does not establish that he was exposed to ionizing radiation in service. 2. The evidence does not establish that the veteran was exposed to an herbicide agent as defined in 38 C.F.R. § 3.307(a)(6), specifically 2,4-D, 2,4,5-T and its contaminant TCDD; cacodylic acid; or picloram during service, nor does it establish that he was exposed other toxic substances including carcinogenic polynuclear aromatic hydrocarbons (PAHs), polychlorinated biphenyls (PCBs), or any dioxin other than TCDD during service. 3. The veteran's DFSP was not present during service or for many years after service, and there is no competent evidence that relates the veteran's DFSP to service or any incident of service. CONCLUSION OF LAW DFSP was not incurred in or aggravated in active service, nor may it be presumed to have been incurred therein. 38 U.S.C.A. §§ 1101, 1110, 1112, 1116, 5107 (West 2002 & Supp. 2007); 38 C.F.R. §§ 3.303, 3.307, 3.309, 3.311 (2006). REASONS AND BASES FOR FINDINGS AND CONCLUSION VA duty to notify and assist Before assessing the merits of the appeal, VA's duties under the Veterans Claims Assistance Act of 2000 (VCAA) must be examined. The VCAA describes VA's duty to notify and assist claimants in substantiating a claim for VA benefits. 38 U.S.C.A. §§ 5100, 5102, 5103, 5103A, 5106, 5107, 5126 (West 2002 & Supp. 2007); 38 C.F.R. §§ 3.102, 3.156(a), 3.159, and 3.326(a) (2006). Upon receipt of a complete or substantially complete application for benefits, VA is required to notify the claimant and his or her representative, if any, of any information, and any medical or lay evidence, that is necessary to substantiate the claim. 38 U.S.C.A. § 5103(a); 38 C.F.R. § 3.159(b); Quartuccio v. Principi, 16 Vet. App. 183 (2002). Proper notice must inform the claimant of any information and evidence not of record (1) that is necessary to substantiate the claim; (2) that the VA will seek to provide; (3) that the claimant is expected to provide; and (4) must ask the claimant to provide any evidence in his or her possession that pertains to the claim. See 38 C.F.R. § 3.159. These notice requirements apply to all five elements of a service connection claim: veteran status, existence of a disability; a connection between the veteran's service and the disability; degree of disability; and the effective date of any award of benefits. See Dingess v. Nicholson, 19 Vet. App. 473 (2006). Such notice must be provided to a claimant before the initial unfavorable decision on a claim for VA benefits is issued by the agency of original jurisdiction. Pelegrini v. Principi, 18 Vet. App. 112, 119 (2004). In this case, in May 1996, the veteran filed a statement in which he said, in pertinent part, that he would like to file a claim for cancer of the chest as a result of radiation exposure. In a letter to the veteran dated in July 1996, the RO notified the veteran that his claim for DFSP, right chest, had previously been denied as not being service connected. The RO went on to say that his claim for chest cancer or DFSP may or not be a radiogenic disease and requested that the veteran furnish facts about his exposure to radiation including the dates and places of the exposure, the organization or unit of assignment and rank at the time of exposure, a detailed description of his duties at the time of exposure, whether a film badge was worn, names of any servicemen with him at the time of exposure, a history of his smoking history and employment history with reference to any history of exposure to radiation or other carcinogens prior to and/or after service, his family history regarding cancer and/or leukemia, as well as medical records regarding the diagnosis and treatment of the claimed condition. In addition, at the November 2000 hearing, the veteran testified regarding his contentions that he was exposed multiple chemical contaminants in service as well as to radiation; at that time he was advised that since he was claiming his DFSP is related to something that happened in service it would be helpful to his case if his doctor, in writing, would set forth that this disorder is related to service in some manner. Specific to the VCAA, it was in a letter dated in April 2002, that the RO notified the veteran that the VCAA had been signed into law in November 2000 and established new notice and development requirements for VA including requiring VA to make reasonable efforts to help him get evidence necessary to support his claim. In that letter, the RO explained that to establish entitlement to service-connected compensation benefits, the evidence must show three things: (1) an injury in service, a disease that began in or was made worse in service, or an event in service causing injury or disease; or, evidence of presumptive condition within a specified time after service (2) a current physical or mental disability; and (3) a relationship between his current disability and an injury, disease, or event in service. The RO explained the relationship between the current disability and service was usually shown by medical records or medical opinions. In another letter also dated in April 2002, the RO noted that the veteran had claimed his cancer of the right side of the chest was due to exposure to a chemical herbicide, commonly known as Agent Orange. The RO listed certain soft-tissue sarcomas as among those that had been found to be related to herbicide exposure. The RO noted that the veteran was claiming exposure to Agent Orange while he was stationed on Guam and requested that he provide any evidence he had that would show he was exposed to Agent Orange while on Guam. In both April 2002 letters, the RO said that it would obtain service records from the military, if appropriate, and would obtain any medical records from VA medical centers. The RO also notified the veteran that he should complete and return release authorizations for doctors or hospitals where he had received treatment and notified him that he should tell VA about any additional information or evidence that he wanted VA to try to get for him. The RO told the veteran that VA would try to help him get such things as medical records, employment records, or records from other Federal agencies. The RO also explained that he must give VA enough information about these records so that VA could request them from the person or agency that had them and emphasized that it was still his responsibility to make sure VA received those records. In addition, in a letter to the veteran dated in May 2003, the RO again stated it was working on his claim for service connection for DFSP claimed due to exposure to radiation and/or herbicides. It noted that he had submitted numerous documents in conjunction with his claim, but reiterated the information needed, including the dates, places and circumstance of his exposure to ionizing radiation if not already provided, and the RO also requested the veteran provide information about his smoking history and family history regarding cancer. The RO again specified what the evidence must show to establish service-connected compensation benefits. The RO again stated that it would try to help him get such things as medical records, employment records, or records from other Federal agencies. It reiterated that he must give VA enough information about these records so that it could request them from the person or agency that has them. The RO explained that it had initiated follow-up to the National Archives Facility in San Bruno, California, and College Park, Maryland, for records regarding the USS HANCOCK (CVA-19) [previously requested by the veteran]. The RO requested that the veteran tell the RO about any additional information or evidence he wanted VA to try to get for him and advised him he was also free to submit any additional pertinent evidence, medical or other records in his possession. In addition, in a March 2006 letter, the RO notified the veteran that when VA found disabilities to be service connected, it assigned a disability rating and an effective date. The RO described the kind of evidence considered in determining a disability rating and an effective date and provided examples of the evidence the veteran should identify or provide with respect to disability ratings and effective dates. In view of the foregoing, the Board finds that the veteran was effectively informed to submit all relevant evidence in his possession and that he received notice of the evidence needed to substantiate his service connection claim, the avenues by which he might obtain such evidence, and the allocation of responsibilities between himself and VA in obtaining such evidence. See Beverly v. Nicholson, 19 Vet. App. 394, 403 (2005); see also Mayfield v. Nicholson, 19 Vet. App. 103, 109-12 (2005) (Mayfield I) rev'd on other grounds, 444 F.3d 1328 (Fed. Cir. 2006). In reaching this conclusion, the Board acknowledges that in a May 2006 letter, the veteran's attorney argued that the notice provided did not comply with the holding of the United States Court of Appeals for the Federal Circuit (Federal Circuit) in Mayfield v. Nicholson, 444 F.3d 1328 (Fed. Cir. 2006) (Mayfield II), cited above, and that his client was materially prejudiced. The Board points out, however, that in Mayfield II the Federal Circuit held that a notice of decision and statements of the case did not satisfy VA's notification obligation under the VCAA in as much as those documents did not advise the claimant, prior to decision on her claim for service-connected death benefits, of information needed to substantiate that claim, did not indicate what information VA would provide and what information the claimant was responsible for obtaining. 444 F.3d at 1332. In this case, the letters outlined above, as opposed to decision notice or statements of the case, provided the necessary notice to the veteran. Further, to the extent that the veteran's attorney is arguing that the notice to the veteran was inadequate and did not provide case-specific notice of what evidence is missing to substantiate the veteran's claim, the Board finds this argument is without merit because VA has no duty to provide this type of notice. Mayfield v. Nicholson, 20 Vet App. 537 (2006) (Mayfield III) citing Locklear v. Nicholson, 20 Vet. App. 410, 415-16 (stating that section 5103(a) does not require predecisional adjudication of evidence and the duty to notify deals with evidence gathering, not an analysis of already gathered evidence). As to timing of notice, the Federal Circuit has held that timing-of-notice errors can be "cured" by notification followed by readjudication. Mayfield II, 444 F.3d at 1333- 34; see Prickett v. Nicholson, 20 Vet. App. 370, 376 (2006) ("The Federal Circuit specifically mentioned two remedial measures: (1) The issuance of a fully compliant [section 5103(a)] notification, followed by (2) readjudication of the claim."); Pelegrini v. Principi, 18 Vet. App. 112, 122-24 (2004) ("proper subsequent VA process" can cure error in timing of notice). The most recent notice was given to the veteran in March 2006, and the RO thereafter readjudicated the veteran's claim and issued supplemental statements of the case (SSOC) in May 2006 and May 2007. The United States Court of Appeals for Veterans Claims (Court) has held that a SSOC that complies with applicable due process and notification requirements constitutes a readjudication decision. Mayfield III, 20 Vet. App. at 541-42; see also Prickett v. Nicholson, 20 Vet. App. 370 (2006) (holding a Statement of the Case that complies with all applicable due process and notification requirements constitutes a readjudication decision). As the SSOCs complied with the applicable due process and notification requirements for a decision, they constitute readjudications of the claim. As a matter of law, the provision of adequate notice followed by a readjudication "cures" any timing problem associated with inadequate notice or the lack of notice prior to an initial adjudication. Mayfield III, citing Mayfield II, 444 F.3d at 1333-34. VA also has a duty to assist the veteran in obtaining evidence necessary to substantiate the claim. 38 U.S.C.A. § 5103A. The RO has obtained the veteran's service medical records and VA medical records, and a Social Security Administration decision pertaining to the veteran is of record. The RO took action to attempt to obtain records requested by the veteran pertaining to the USS HANCOCK during the period the veteran was assigned to her, and also requested information and evidence from the Navy Department, the Department of Defense and the National Personnel Records Center pertaining to the veteran's claimed exposure to ionizing radiation and herbicides as defined in 38 C.F.R. § 3.307(e). The veteran has submitted many reports and research articles, which he contends demonstrate that he was exposed to ionizing radiation and toxic chemicals, including herbicides while in service. The RO has assisted the veteran by following the procedures outlined in 38 C.F.R. § 3.311 in the development of a claim based on exposure to ionizing radiation. In addition, the RO obtained an opinion from the Surgeon General of the Navy at the Navy Bureau of Medicine and Surgery as to whether the veteran was exposed to a herbicide agent as defined in 38 C.F.R. § 3.307(e), specifically 2,4-D; 2,4,5,-T and its contaminant TCDD; cacodylic acid; or picloram during service and an opinion as to whether the veteran was exposed to carcinogenic PAHs, PCBs, and/or dioxins (other than TCDD) during service. Based on the foregoing, the Board concludes that the veteran has received adequate notice, and relevant evidence has been obtained for determining the merits of the veteran's claim. The Board finds that no further assistance to the veteran is required and that the Board may proceed with its decision. Legal criteria In general, service connection may be granted for disability resulting from disease or injury incurred in or aggravated during active military service. 38 U.S.C.A. § 1110. Service incurrence of a malignant tumor may be presumed if manifested to a degree of 10 percent or more within one year of separation from active service. 38 U.S.C.A. §§ 1101, 1112; 38 C.F.R. §§ 3.307(a)(3), 3.309(a). Service connection may also be established for disease diagnosed after discharge from service when all the evidence establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d). Service connection for a condition that is claimed to be attributable to ionizing radiation exposure during service may be established in one of three different ways, which have been outlined by the Court. See Davis v. Brown, 10 Vet. App. 209, 211 (1997); Ruker v. Brown, 10 Vet. App. 67, 71 (1997). First, where it is contended that disease developed as a result of exposure to ionizing radiation during service, service incurrence may be presumed under 38 U.S.C.A. § 1112(c) and 38 C.F.R. § 3.309(d) for veterans who participated in defined radiation risk activities and have certain diseases. Second, service connection may be established under 38 C.F.R. § 3.303(d) with the assistance of the procedural advantages prescribed in 38 C.F.R. § 3.311 if certain conditions are met. Third, direct service connection can be established under 38 C.F.R. § 3.303(d) by showing that the disease was incurred during or aggravated by service without regard to the statutory presumptions. See Combee v. Brown, 34 F.3d 1039, 1043-44 (Fed. Cir. 1994). As it applies to 38 U.S.C.A. § 1112(c) and 38 C.F.R. § 3.309(d), the term "radiation-exposed veteran" means a veteran who participated in a "radiation-risk activity." 38 U.S.C.A. § 1112(c)(3)(A); 38 C.F.R. § 3.309(d)(3)(i). The term "radiation-risk activity" means: onsite participation in a test involving the atmospheric detonation of a nuclear device (onsite participation includes assignment to official military duties at Naval Shipyards involving the decontamination of ships that participated in Operation Crossroads); the occupation of Hiroshima or Nagasaki, Japan, during the period beginning on August 6, 1945, and ending on July 1, 1946; internment as a prisoner of war of Japan during World War II resulting in an opportunity for exposure to radiation comparable to those occupying Hiroshima or Nagasaki; certain service on the grounds of a gaseous diffusion plant in Paducah, Kentucky, Portsmouth, Ohio, or at area K25 at Oak Ridge, Tennessee; or certain service on Amchitka Island, Alaska. See 38 U.S.C.A. § 1112(c)(3)(B); 38 C.F.R. § 3.309(d)(3)(ii). Diseases presumptively service connected for radiation- exposed veterans under the provisions of 38 U.S.C.A. § 1112(c) and 38 C.F.R. § 3.309(d) are: leukemia (other than chronic lymphocytic leukemia), cancer of the thyroid, cancer of the breast, cancer of the pharynx, cancer of the stomach, cancer of the small intestine, cancer of the pancreas, multiple myeloma, lymphomas (except Hodgkin's disease), cancer of the bile ducts, cancer of the gall bladder, primary liver cancer (except if cirrhosis or hepatitis B is indicated), cancer of the salivary gland, cancer of the urinary tract, bronchiolo-alveolar carcinoma, cancer of the bone, cancer of the brain, cancer of the colon, cancer of the lung, and cancer of the ovary. 38 U.S.C.A. § 1112(c)(2); 38 C.F.R. § 3.309(d)(2). As noted above, in radiation claims, the second approach is found in 38 C.F.R. § 3.311. To consider a claim under § 3.311, the evidence must show the following: (1) the veteran was exposed to ionizing radiation in service; (2) he subsequently developed a radiogenic disease; and (3) such disease first became manifest within a period specified by the regulation. 38 C.F.R. § 3.311(b). If any of the foregoing three requirements has not been met, service connection for a disease claimed as secondary to exposure to ionizing radiation cannot be granted under 38 C.F.R. § 3.311. 38 C.F.R. § 3.311(b)(1)(iii). For purposes of 38 C.F.R. § 3.311, the term "radiogenic disease" means a disease that may be induced by ionizing radiation. 38 C.F.R. § 3.311(b)(2). The regulation states that the term radiogenic disease shall include: (i) All forms of leukemia except chronic lymphatic (lymphocytic) leukemia; (ii) Thyroid cancer; (iii) Breast cancer; (iv) Lung cancer; (v) Bone cancer; (vi) Liver cancer; (vii) Skin cancer; (viii) Esophageal cancer; (ix) Stomach cancer; (x) Colon cancer; (xi) Pancreatic cancer; (xii) Kidney cancer; (xiii) Urinary bladder cancer; (xiv) Salivary gland cancer; (xv) Multiple myeloma; (xvi) Posterior subcapsular cataracts; (xvii) Non-malignant thyroid nodular disease; (xviii) Ovarian cancer; (xix) Parathyroid adenoma; (xx) Tumors of the brain and central nervous system; (xxi) Cancer of the rectum; (xxii) Lymphomas other than Hodgkin's disease; (xxiii) Prostate cancer; and (xxiv) Any other cancer. 38 C.F.R. § 3.311(b)(2). Section 3.311(a) calls for the development of a radiation dose assessment where it is established that a radiogenic disease first became manifest after service, where it was not manifest to a compensable degree within any applicable presumptive period specified in either 38 C.F.R. § 3.307 or § 3.309, and where it is contended that the disease is a result of ionizing radiation in service. Dose data will be requested from the Department of Defense in claims based upon participation in atmospheric nuclear testing and in claims based upon participation in the American 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 that 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. Id. Finally, direct service connection can be established by "showing that the disease or malady was incurred during or aggravated by service," a task which "includes the difficult burden of tracing causation to a condition or event during service." Combee v. Brown, 34 F.3d 1039, 1043 (Fed. Cir. 1994). In order to prevail on direct service connection there must be medical evidence of a current disability; medical evidence, or in certain circumstances, lay evidence of in-service occurrence or aggravation of a disease or injury; and medical evidence of a nexus between an in-service injury or disease and the current disability. See Hickson v. West, 12 Vet. App. 247, 253 (1999); see also Pond v. West, 12 Vet App. 341, 346 (1999). If a veteran was exposed to an herbicide agent during active military, naval, or air service, the following diseases shall be service-connected if the requirements of 38 C.F.R. § 3.307(a)(6) are met, even though there is no record of such disease during service, provided further that the rebuttable presumption provisions of 38 C.F.R. § 3.307(d) are also satisfied: chloracne or other acneform diseases consistent with chloracne, Type 2 diabetes (also known as Type II diabetes mellitus or adult-onset diabetes), Hodgkin's disease, chronic lymphocytic leukemia, multiple myeloma, non- Hodgkin's lymphoma, acute and subacute peripheral neuropathy, porphyria cutanea tarda, prostate cancer, respiratory cancers (cancer of the lung, bronchus, larynx, or trachea) and soft- tissue sarcomas (other than osteosarcoma, chondrosarcoma, Kaposi's sarcoma, or mesothelioma). 38 U.S.C.A. § 1116; 38 C.F.R. § 3.309(e). The diseases listed at 38 C.F.R. § 3.309(e) shall have become manifest to a degree of 10 percent or more at any time after service, except that chloracne or other acneform disease consistent with chloracne, porphyria cutanea tarda, and acute and subacute peripheral neuropathy shall have become manifest to a degree of 10 percent or more within a year after the last date on which the veteran was exposed to an herbicide agent during active military, naval, or air service. 38 C.F.R. § 3.307(a)(6)(ii). For the purposes of 38 C.F.R. § 3.307, the term herbicide agent means a chemical in an herbicide used in support of the United States and allied military operations in the Republic of Vietnam during the period beginning on January 9, 1962, and ending on May 7, 1975, specifically: 2,4-D, 2,4,5-T and its contaminant TCDD; cacodylic acid; and picloram. 38 C.F.R. § 3.307(a)(6)(i). As noted earlier, the Federal Circuit has determined that a veteran is not precluded by presumptive laws and regulations from establishing service connection with proof of actual direct causation. Combee v. Brown, 34 F.3d 1039, 1042 (Fed. Cir. 1994). Background and analysis The veteran is seeking service connection for DFSP of the chest and contends that this soft-tissue sarcoma, which is shown by the medical evidence of record to have been diagnosed in 1983, is due to exposure to radiation or herbicide agents in service as well as exposure to many other contaminants in the environments in which he served. Presumptive service connection - 38 C.F.R. § 3.309 (i) 38 C.F.R. § 3.309(a) - chronic disease The Board notes that a malignant tumor is considered a chronic disease under 38 C.F.R. § 3.309(a), and that presumptive service connection is warranted if such disease develops to a compensable level within a year of discharge from service as prescribed by 38 C.F.R. § 3.307(a)(3). The record shows that when a biopsy was done in October 1979, a nodule on the veteran's right chest had been found to be a benign dermatofibroma, but in the year prior to surgery, which was in November 1983, the nodule had grown rather rapidly, and histological study prior to surgery revealed that it had undergone what was describe as sarcomatous degeneration to a dermatofibrosarcoma protuberans. There is no earlier medical evidence of malignant tumor prior to 1983, which precludes a grant of service connection for DFSP based on development of a chronic disease under the provisions of 38 C.F.R. § 3.309(a). (ii) radiation-exposed veteran - 38 C.F.R. § 3.309(d) Although the veteran contends his DFSP is due to due to exposure to ionizing radiation in service, at no time has he contended, nor does the evidence show, that he participated in a "radiation-risk activity" as defined by 38 C.F.R. § 3.309(d), which is an essential element for consideration of his claim on a presumptive basis under 38 C.F.R. § 3.309(d). Further, DFSP is not among the diseases for which service connection may be granted on a presumptive basis under 38 U.S.C.A. § 1112(c) and 38 C.F.R. § 3.309(d). See Rucker, 10 Vet. App. at 71. (iii) disease associated with exposure to herbicides - 38 C.F.R. § 3.309(e) The veteran also contends, in effect, that his DFSP should be service-connected on a presumptive basis under the provisions of 38 U.S.C.A. § 1116 and 38 C.F.R. § 3.309(e) and 38 C.F.R. § 3.307, which pertain to veterans exposed to herbicides. The medical evidence shows that DFSP is a soft-tissue sarcoma, which is one of the diseases for which service- connection may be granted on a presumptive basis under the provisions of 38 C.F.R. § 3.309(e). While 38 C.F.R. § 3.307(a)(6)(iii) allows a presumption of exposure to herbicides for Vietnam era veterans who had service in the Republic of Vietnam, include service in the waters offshore and duty or visitation in the Republic of Vietnam, the evidence does not show, nor does the veteran contend that he was ever in Vietnam or its offshore waters. The veteran contends that he was exposed to many contaminants while in service and that they include Vietnam era herbicides. If it can be shown that the veteran was exposed to an herbicide agent listed at 38 C.F.R. § 3.307(a)(6), that is, 2,4-D, 2,4,5-T and its contaminant TCDD, cacodylic acid, or picloram, service connection may be granted for his DFSP on a presumptive basis. The veteran's service personnel records show he was at the Naval Communications Station (NCS) on Guam from February 1966 to May 1967 with one month temporary duty at the Naval Communications Station on Okinawa. He reported to the USS HANCOCK (CVA-19) in July 1967 and served there until May 1968; during that time the ship was in overhaul at dry dock #3 at Hunters Point Naval Shipyard. The veteran reports that he lived on the ship during the first few months of the overhaul and after that lived in barracks. The veteran reports that while he was stationed on Guam, he witnessed spraying on a regular basis, which he believes included insecticides, DDT, and herbicides like Agent Orange. He states that just after he arrived at the NCS, a baseball field was made or expanded with the use of herbicides, and he reports that he played baseball throughout the time he was on Guam. He maintains that the drinking water was contaminated, and he also reports that he ate the local food such as fish, coconut crabs, local pork, and coconuts on a regular basis while he was on Guam. The veteran asserts that the rainbow herbicides, silvex and DDT were all used or stored on Guam, and he states he knows veterans who used Agent Orange during the 1960s and as early as 1962 and as late as 1969. He states he saw these herbicides being used in 1966 and 1967. In addition, the veteran states that Silvex, 2,4,5-TP, can be found throughout the drinking water system of Guam. The veteran's service personnel records show that from August 1967 to May 1968 he was part of the crew of the USS HANCOCK during overhaul. He reports that the radio crew to which he was assigned did a variety of tasks on the base and shipboard. He asserted that the ship was contaminated with Agent Orange, dioxin and other herbicides, especially in the water systems such as the water compartment he had to overhaul. He contends that this was related to the ship's service off Vietnam handling aircraft that flew Agent Orange missions over Vietnam. The veteran also contends exposure to multiple toxic materials, including dioxin, from the shipyard itself. The veteran has submitted letters and photos from servicemen who were in the Air Force and stated they were sent to Guam. They mention the years 1967, 1968, and 1969 and state that their jobs included loading, unloading, and stockpiling drums of Agent Orange and other hazardous chemicals as well as transporting them in trucks for the supply yard to airplanes. One stated that sometimes they dropped the drums, or ran a forklift through one, but this was not something they reported. Another reported that one of the photos, which shows what appears to be a field of dry, brown grass or cane, was a field that was sprayed to make a supply yard. The veteran has also submitted many documents in conjunction with his claim, all of which have been reviewed by the Board. Documents submitted by the veteran include excerpts from congressional hearing testimony, reports from the U.S. General Accounting Office, the U.S. Environmental Protection Agency, Guam Environmental Protection Agency, the Agency for Toxic Substance and Disease Registry, and many others. The reports, for example, discuss the presence and level of dioxin in soil at various locations on Anderson Air Force Base and the presence of 2,4-D at various locations on Guam, including wells at the NCS. The reports also address the presence and level of various contaminants at Hunters Point where the USS HANCOCK was in dry dock. The veteran in effect argues that from all the evidence it must be found that he was exposed to herbicide agents in service and that service connection for his DFSP may be granted on a presumptive basis. In its November 2006 remand, the Board outlined in detail evidence submitted by the veteran, which in the Board's judgment indicated that it was plausible that the veteran was exposed to herbicide agents, dioxin and/or 2,4-D in service. At the request of the Board, the Surgeon General of the Navy was provided copies of many documents, including the reports mentioned above and those include a document titled Public Health Assessment, Anderson Air Force Base, as well as the veteran's service personnel records. He was, in addition, provided a copy of a September 2003 letter from the Principal Under Secretary of Defense for Installations and Environment. In the September 2003 letter, the Under Secretary stated the Department of Defense had found no record of the use, storage, or testing of Herbicides, Orange, Blue, or White on Guam. He said that in 1952, roughly 5,000 drums of Herbicide Purple were stored on Guam, but was never used and was returned to the United States. He also said that although other herbicides may have passed through Guam during the Vietnam Conflict, the Department has no record of long-term storage or use of these herbicides on Guam. The Under Secretary said that according to the Air Force studies, dioxins at sites reference in the Public Health Assessment [one of the documents submitted to VA by the veteran] were associated with burned material. He went on to say that access to sites on Guam with elevated dioxin levels is highly restricted and public exposure is not expected. In a letter dated in April 2007, the Surgeon General of the Navy, Bureau of Medicine and Surgery, outlined the veteran's service based on his service personnel records and indicated that he had before him the Board's November 2006 remand outlining the veteran's contentions and his reported activities. The Surgeon General noted that the available information and evidence did not directly cover the period of the veteran's service, but based on his review, he concluded that the veteran was not likely to have been exposed to a herbicide agent as defined in 38 C.F.R. § 3.307(a)(6), specifically: 2,4-D; 2,4,5-T and its contaminant TCDD; cacodylic acid; or picloram during his service. The veteran has in effect argued that that no weight should be given to the opinion of the Navy Surgeon General because he did not consider all the evidence of record including evidence that severe contamination of the drinking water on Guam was found in 1978. The veteran emphasizes that and before that there was no treatment of the drinking water, the drinking water for the military was untreated for contaminants, and the water was not even diluted to bring down the contaminants. The veteran essentially asserts that it should be concluded that he was exposed to a herbicide agent in service with exposure by way of the drinking water, the air he was breathing, as well as the water he showered or washed up in. He further argues that the Navy Surgeon General was only sent what was needed to determine that he was not exposed to herbicides. Further, the veteran argues that evidence he submitted in January 2007 and February 2007 should have been included in the materials sent to the Navy Surgeon General. The documents submitted by the veteran at that time are reports and correspondence from Professor Luis Syzfres, M.D., MPH, along with a news article reporting statements attributed to Dr. Szyfres and his studies. The reports discuss the presence of toxic chemicals on Guam, their etiology, and distribution as well as the diseases associated with exposure to those chemicals. As indicated by the veteran in his letter forwarding the materials, many of the documents cited and quoted by Dr. Syzfres are the same those submitted to VA by the veteran. These materials are essentially duplicative of evidence concerning toxic chemicals, including 2-4, D and dioxin, previously of record, and do not, in the judgment of the Board warrant obtaining a new opinion from the Surgeon General of the Navy. The Board acknowledges that one document, a copy of an e-mail message from Dr. Szyfres to SenatorWon-Pat, includes information not previously of record. Dr. Szyfres states that various herbicides containing dioxins used during the Vietnam war were all stored in Guam and were disseminated throughout the island by wind, typhoons, infiltration, evaporation, and rains. He further states that the military not only sprayed the dioxins in Vietnam, they also sprayed Guam. For this statement, Dr. Szyfres then cites an interview of Mr. [redacted], but does not identify him further. The Board has considered the evidence submitted by the veteran, which generally indicates that herbicide agents, as defined by 38 C.F.R. § 3.307(e), have been found on Guam at various locations at various times subsequent to the time the veteran was stationed there. There is, however, no evidence that documents the veteran's personal exposure to a herbicide agent, and in May 2002, the National Personnel Records Center, in response to a request from the RO for any documents showing exposure to herbicides for the veteran, said there were no records of exposure for the veteran. Further, although the veteran has at times during the course of the appeal said that he saw spraying of herbicides while he was in Guam, there is no evidence that substantiates his implicit contention that the spray included a herbicide agent at issue here. Statements from service men who were in the Air Force and reported handling and spraying Agent Orange at their base on Guam do not, in the Board's judgment, serve to corroborate the veteran's contention that he was exposed to Agent Orange or that spraying he saw at the NCS contained Agent Orange. Likewise, there is no evidence that substantiates his claim that he was exposed to a herbicide agent while aboard the USS HANCOCK. As noted above, the Navy Surgeon General reviewed representative evidence indicating that it is plausible that the veteran was exposed to dioxin and/or 2,4-D while on Guam. He considered that evidence along with the veteran's service assignment as a radioman as well as his recreational activities as outlined in the November 2006 remand, and concluded the veteran was not likely to have been exposed to a herbicide agent during service. The Board gives great weight to this opinion, which considers the veteran's individual situation, and finds that the preponderance of evidence is against finding that the veteran was exposed to a herbicide agent in service. The Board recognizes that the veteran has submitted copies of a Board decisions pertaining to other veterans. One concerned a veteran who was found to have been exposed to dioxins while serving in Okinawa, and another was a remand in a case where the veteran claimed he had service in the waters adjacent to Vietnam while aboard the USS HANCOCK; the remand was to obtain the veteran's service personnel records and information to attempt to corroborate the veteran's contention that aircraft aboard the carrier transported Agent Orange to Vietnam during the time he served aboard the ship. A third Board decision submitted by the veteran is a decision in which the claimant was a veteran who was in the Air Force and served at Anderson Air Force Base on Guam. That veteran stated that he worked at an air field, the perimeter of which was continuously brown due to spraying every three months, and he reported that he recalled seeing storage barrels at the edge of the base. The Board decision stated that he submitted copies of articles indicating that Agent Orange may have been stored and/or used on Guam from 1955 to the late 1960s. The Board also stated that the articles also reflected that in the 1990s the EPA tested Anderson Air Force base as a toxic site with dioxin contaminated soil and ordered clean up of the site. The Board said that based on this evidence, it accepted that the veteran was exposed to herbicides during his active service in Guam. The Board must of course point out that Board decisions are not precedential. 38 C.F.R. § 20.1303 (2006) Rather, the Board must weigh the facts of each case and apply the governing laws and regulations without regard to dispositions in other veterans' cases based on separate and unique facts. As previously stated, in this case, the veteran was in the Navy and was assigned to NCS. The Navy Surgeon General considered the veteran's duties and recreational activities along with multiple research reports and articles, including the one showing the EPA tested Anderson Air Force base as a toxic site with dioxin-contaminated soil, and concluded that the veteran was not likely exposed to a herbicide agent. Weighing this and the remaining evidence, the Board has found in this case that the preponderance of the evidence is against finding that the veteran was exposed to a herbicide agent in service. In the absence of finding that the veteran was exposed to a herbicide agent in service, service connection for the veteran's DFSP may not be granted on a presumptive basis under the provisions of 38 U.S.C.A. § 1116 and 38 C.F.R. § 3.309(e). 38 C.F.R. § 3.311 Whether the veteran's DFSP is due to exposure to ionizing radiation in service must be considered under 38 C.F.R. § 3.311, which applies to any cancer. The Board notes that the regulation provides that 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 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). The provisions of 38 C.F.R. § 3.311 do not give rise to a presumption of service connection, but rather establish a procedure for handling claims brought by radiation exposed veterans or their survivors. See Ramey v. Gober, 120 F.3d 1239, 1244 (Fed. Cir. 1997). The veteran contends that he was exposed to radiation in service under various circumstances. He has testified that he was exposed to radiation when there was an accident involving the ship's radar when he was aboard the USS HANCOCK. Further, he has testified he was a subject of an experiment with radioactive material put in his food while he was on Cocos Island for two weeks after he first arrived in Guam, where he was stationed from February 1966 to May 1967. He also contends that he was exposed to ionizing radiation while he was in Guam because of residuals of radioactive fallout from U.S. atmospheric tests in the Pacific from Operation CROSSROADS in 1946 and other tests that continued into the early 1960s. He also asserts exposure to ionizing radiation because Guam was a location for decontamination of ships involved in nuclear weapons testing. He has stated that Apra Harbor and also Cocos Lagoon (where he states he swam during the two weeks he was on Cocos Island) were the areas used for decontamination of ships. In this regard, he has submitted excerpts from DNA 6032F, OPERATION CROSSROADS, which states that the Chief of Naval Operations established decontamination and clearance sites at various locations including San Francisco and Guam. The document lists 17 ships that were sent to Guam. It does not identify the Guam location where decontamination took place. He also submitted a copy of a chart of the Pacific Ocean encompassing Guam and Cocos Island as an area within a rectangle and titled "Possible Significant Nuclear Fallout, Pacific Proving Grounds IVY KING." The chart bears a stamp indicating it was in Department of Energy Archives. The record includes a December 1998 letter to the veteran's representative from the Freedom of Information Act (FOIA) officer of the Navy's Bureau of Medicine and Surgery. The officer stated that in a telephone conversation, the veteran stated his concerns regarding exposure to radiation while serving in the Navy related to a recollection of participating in a food experiment on Cocos Island in 1966 involving the ingestion of a radioactive substance. The FOIA officer stated that a thorough search revealed no documentation of a study involving the administration of a radioactive substance on Cocos Island. He stated that in 1971 the Department of Defense had documented military studies involving human exposure to radiation and that none of the identified studies confirmed the description provided by the veteran. In April 1999, the RO requested information and documents from the service department via the National Personnel Records Center (NPRC) stating it was requesting any information regarding the veteran's exposure to radiation either through a radar unit leak aboard the USS HANCOCK between November 1967 and May 1968 at Hunters Point, San Francisco, California. The RO also requested that NPRC verify the veteran's participation in a two-week temporary duty on Cocos Island, which was claimed decontamination point for vessels participating in atomic detonation tests. The RO requested that the NPRC furnish the veteran's service personnel records and any DD 1141 or other records of exposure to radiation. In May 1999, the NPRC furnished the veteran's service personnel records and reported that the document or information requested pertaining to exposure to radiation was not a matter of record. In July 2001, the veteran submitted a letter sent to him by the Director, Environmental Protection, Safety and Occupational Health Division of the Office of the Chief of Naval Operations. The Director stated to the veteran that despite an extensive search, his office had not found any documentation regarding his recollection of having been fed a radioactive substance as part of a military experiment which he was stationed on Guam. He said that similarly, they had found no record that he was exposed to radiation while serving aboard the USS HANCOCK. No radiation exposure reports pertaining to the veteran were found during their review of the Navy's database of personnel radiation exposures, nor did they find any record that the USS HANCOCK had participated in earlier nuclear weapons tests in the Pacific. He also stated that they failed to find any record of Department of Defense studies of health status of military personnel who had been stationed on Guam during the period from 1946 to 1986. In March 2003, the veteran submitted a report titled "Blue Ribbon Panel Committee Action Report ON Radioactive Contamination I Guam Between 1946-1958." The authors discuss preliminary findings of nuclear contamination on Guam and cite U.S. nuclear testing in and around the Marshall Islands, the distance to Guam, the weapon yields, radioactive materials carried by the jet stream and dropped on Guam in the form of rain, the Navy's knowledge of that information, decontamination of Naval ships in Guam harbors (citing Operation CROSSROADS, 1946, United States Atmospheric Nuclear Weapons Tests Nuclear Test Personnel Review), and Navy radio ecological sites on surface water in and around Guam that found a major peak of radioactive contamination in 1959. In separate May 2003 letters to the Defense Threat Reduction Agency (DTRA) and to the Navy Environmental Health Center Detachment, Naval Dosimetry Center, the RO stated the veteran's assigned unit had been the USS HANCOCK from August 1967 through April 1968 at Hunters Point Naval Shipyard, which it indicated was the site of a shipboard accident, and also stated the veteran served on Cocos Island, Guam. The RO stated the veteran's duties include radio crewman and he alleged exposure to radiation from radar, contaminated water on Cocos Island, and food experiments aboard ship. In each letter, the RO requested that the addressee verify the veteran's participation in the described activities and provide the associated radiation dose. The RO further stated that if no individual radiation dose records were available that the addressee provide a dose reconstruction for the veteran's unit. In a letter dated in May 2003, the Head of the Administrative Department of the Naval Dosimetry Center replied to the RO's letter. The Naval Dosimetry Center letter stated that a review of its exposure registry by both name and social security number revealed no record of occupational exposure to ionizing radiation pertaining to the veteran. It sated that it was unable to verify the veteran's participation in radiation risk activities and noted that the ship to which the veteran was assigned, the USS HANCOCK, was a conventionally-powered aircraft carrier, so any radiation form sources identified by the veteran in his statement would have been negligible. It stated that the radiation associated with communications is non-ionizing and there would be no record of exposure monitoring in this case, because there are no known biological effects attributed to cumulative exposure. It went on to say that exposure to non- ionizing radiation has not been established as causing or contributing to the development of cancer. In a letter dated in June 2003, the DTRA replied to the RO's May 2003 letter. The DTRA noted that the RO's inquiry indicated that the veteran was exposed to radiation while serving aboard the USS HANCOCK and at Cocos Island, Guam, between 1966 and 1968. DTRA stated it was returning the inquiry and pointed out that the scope of its program was limited to providing information regarding the activities and radiation exposure histories of individuals who participated in U.S. atmospheric nuclear tests (1945 to 1962) and the occupation of Hiroshima and Nagasaki, Japan, following World War II. DTRA stated that exposure to radiation from other sources is beyond its purview. DTRA pointed out that per 38 C.F.R. § 3.311(a)(2)(iii), VA is tasked with requesting available records concerning the veteran's exposure to all other radiation claims that are not for U.S. atomic veterans or Hiroshima and Nagasaki occupation sources. It stated that furthermore this CFR citation specifies that all collected records will be forwarded to the Under Secretary of Health who is responsible for preparing a dose estimate. DTRA stated its program is not responsible for preparing these dose estimates. DTRA suggested the RO send its inquiry to the Naval Dosimetry Center. In a letter to the RO dated in February 2005, the veteran submitted an article titled "Elevated Levels of Ferromagnetic Metals in Foodchains Supporting the Guam cluster of neurodegeneration: Do metal nucleated crystal contaminants evoke magnetic fields that initiate the progressive pathogenesis of neurodegeneration?" Medical Hypotheses (2004) 63, 793-809. The veteran states that the article shows that Cocos Island was a decontamination station for ships from nuclear weapons testing. He also mentions the concentration of strontium in the soil on the base "where I was assigned for experiments." Review of the article shows that the author states there was radioactive decontamination of naval vessels in the Cocos and "Agat" naval bases during what he says was the Operation CROSSROAD period of the late 1940s to 1960s. He also said it was very likely that the foodchain had become contaminated with radionuclide metals that were discharged from the decks of the boats involved in the atomic weapon detonations, such as strontium (Sr) 90, cesium 136. The Board notes that 38 C.F.R. § 3.309(d) shows that Operation CROSSROADS was conducted in July and August 1946 and that the portions of DNA 6032F Operation CROSSROADS submitted by the veteran discusses decontamination operations in 1946 and 1947. The Board also notes that the author of the 2004 article cites this document and a 2003 article titled "Teaching Ethics" Society for Ethics across the curriculum, vol 3 (2). As noted earlier DNA 6032F does not specify the Guam location for decontamination operations. In a March 6, 2006, letter to DTRA, the RO explained that it was currently processing a claim for the veteran and that he contends he was exposed to radiation while stationed on Guam from about February 1966 to June 1967. The RO stated that the veteran is not contending that he was involved in atmospheric testing, but instead his contention is that the southern area of Guam, specifically the Cocos Island and lagoon areas were used as decontamination sites for ships that participated in atmospheric testing. The RO stated it needed to know whether DTRA could confirm that the Cocos Island and lagoon areas of Guam were in fact used as decontamination sites for ships that participated in atmospheric testing. In a March 15, 2006, letter, DTRA responded to the RO's letter. DTRA indicated that the RO inquiry related to the veteran being stationed at Guam from 1966 to 1967 and stated it had reviewed the veteran's file and concluded that the information in its June 2003 letter remained current. In a March 22, 2006, letter to Senator Reid, DTRA thanked the senator for his inquiry on behalf of the veteran who, it noted, had expressed concern about the status of his VA claim and DTRA's input to that claim. DTRA explained that it is the executive agent for the Department of Defense Nuclear Test Personnel Review Program (NTPR), which confirms veteran participation in U.S. atmospheric nuclear tests (1945 to 1962) and the American occupation forces of Hiroshima and Nagasaki, Japan. DTRA explained that the NTPR program may also provide the actual or estimated radiation dose received by a confirmed participant and that VA could request this information in support of its claim review process. In its March 2006 letter to Senator Reid, DTRA went on to say that it had recently received VA's request that DTRA confirm Cocos Island and the lagoon areas of Guam as sites used for decontamination of ships that participated in atmospheric testing and that according to VA the veteran contends that he was exposed to radiation while stationed on Guam from February 1966 to June 1967. DTRA stated that it is not the agency with access to records to confirm the veteran's participation in these activities and said that it had notified VA that the veteran's claimed exposure does not fall within the scope of its program and that military records do not confirm his participation in atmospheric testing as defined in 38 C.F.R. § 3.309. DTRA suggested that for information regarding his activities and potential exposure to radiation while stationed on Guam during military service the veteran contact the National Archives and Records Administration, the Naval Historical Center, and the Naval Dosimetry Center. The Board notes that the claims file includes extensive correspondence dating from 1996 to and from the offices of the National Archives and Records Administration in College Park, Maryland, and San Bruno, California, concerning requests for documents and information related to the veteran's claim. That organization has provided documents related to the USS HANCOCK showing it was in overhaul at Hunters Point during the time of the veteran's assignment and identified records documenting the overhaul and repair work done on the USS HANCOCK. It took some time to locate and obtain permission to obtain those documents, and in the most recent correspondence, which is dated in May 2003, the National Archives and Records Administration office for the Pacific Region stated that an inquiry of its current Navy holdings did not indicate that any of the records in its physical custody would be relevant to the records that the RO was attempting to locate. Correspondence stated that the records were related to shipyard activities and did not include personnel service records as such and it was unlikely they contained any information relevant to the inquiry. Further, on a VA Form 119, Report of Contact, dated in April 2003, the RO documented a telephone call to the Naval Historical Center describing the veteran's contention of having been exposed to radiation on Cocos Island, Guam, in 1966 to 1967. The Naval Historical Center librarian stated that the Naval Historical Center would have no information that confirms the possibility of radiation exposure in such a manner. And the Board again notes that in its May 2003 letter, the Naval Dosimetry Center reported it had no record of occupational exposure to ionizing radiation for the veteran and could not verify his participation in radiation risk activities. In April 2006, pursuant to the provisions of 38 C.F.R. § 3.311, the RO forwarded the veteran's entire claims file to the Director of the Compensation and Pension Service requesting referral to the Under Secretary for Health for the preparation of a radiation dose estimate. In a May 2006 memorandum, the Director of the Compensation and Pension Service reported that the veteran asserted that between 1966 and 1968 he had been exposed to radiation while on Guam and board the USS HANCOCK. The director outlined the actions taken by the RO to develop the claim and requested that the Undersecretary for Health review the available records and prepare a dose estimate, to the extent feasible, based on available methodologies, and further if a dose estimate could be provided, requested a medical opinion from the Under Secretary for Health addressing whether it is likely, unlikely, or as likely as not that the veteran's DFSP resulted from exposure to radiation in service. In a May 2006 Radiation Review memorandum, the VA Chief Public Health and Environmental Hazards Officer noted the veteran's contentions regarding exposure to ionizing radiation including on Cocos Island, Guam, and while on the USS HANCOCK while in dry dock at Hunters Point Naval Shipyard. It was noted that no DD Form 1141 or other documentation of exposure to ionizing radiation during service (other than dental and chest X-rays) was identified and that letters from the Navy did not confirm that the claimed exposures occurred and did not provide any dose information. The Chief Public Health and Environmental Hazards Officer said that based on the information submitted, his office is unable to provide a radiation dose estimate for the claimed exposures. The Director of the Compensation and Pension Service in turn, in a May 2006 Advisory Opinion - Radiation Review Under 38 C.F.R. § 3.311 reported it had received the opinion from the Under Secretary's staff that advised they were unable to provide a radiation dose estimate for the veteran. As directed by 38 C.F.R. § 3.311, and as outlined above, the RO requested any available records concerning the veteran's exposure to ionizing radiation and the Under Secretary for Health was requested to prepare a dose estimate for the veteran, but was unable to do so, which for purposes of the regulation, the Board regards as a finding that the veteran was not exposed to ionizing radiation. Although the veteran has submitted articles and reports suggesting that radioactive materials have been present or found on or near Guam and at Hunters Point Naval Shipyard at various times, those materials do not establish a radiation dose estimate for the veteran or even show that the veteran was in fact exposed to ionizing radiation as he contends. Under the provisions of 38 C.F.R. § 3.311(b)(1), when there is a determination that the veteran was not exposed to ionizing radiation, it shall not be determined that the claimed disease has resulted from ionizing radiation. The Board acknowledges that the veteran's long-held belief and contentions that he was exposed to ionizing radiation and that his DFSP is related to that exposure. It is, however, well established that lay persons without scientific or medical training, such as the appellant, are not competent to provide a probative opinion on medical matters of diagnosis and nexus. See Espiritu v. Derwinski, 2 Vet. App. 492, 494-5 (1992); see also 38 C.F.R. § 3.159 (a) (competent medical evidence means evidence provided by a person who is qualified by education, training or experience to offer medical diagnoses, statements or opinions). Thus, the veteran's own opinion that he was exposed to ionizing radiation in service and that exposure caused his DFSP, his opinion is entitled to no weight or probative value. Accordingly, the Board concludes that taking into consideration the provisions of 38 C.F.R. § 3.311, the preponderance of the evidence is against the claim. Direct service connection - Combee Notwithstanding the foregoing, the Federal Circuit in Combee determined that the regulations governing presumptive service connection do not preclude a claimant from establishing service connection with proof of actual direct causation. See Combee, 34 F. 3d. at 1043-44; see also 38 C.F.R. § 3.303 (d). Accordingly, the Board will proceed to evaluate the claim on the regulations governing service connection. As discussed above, in order to establish 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) competent evidence of a nexus between an in-service injury or disease and the current disability. See Hickson v. West, 12 Vet. App. 247, 253 (1999). There is no question that element (1) has been met. The Board's discussion will therefore focus on elements (2) and (3). As discussed earlier, the veteran contends that his DFSP is due to exposure to ionizing radiation or herbicide agents in service as well as exposure to many other contaminants in the environments in which he served. He maintains that exposures to all these materials took place when he was on Guam and while he was assigned to the USS HANCOCK as she underwent overhaul at Hunters Point, California. As to the radiation exposure, an event he has focused on is a radar accident, which he states took place while on the USS HANCOCK and after which he was reportedly told that he was exposed to 70 or 80 rads of ionizing radiation. The Board notes, however, that the Court has taken judicial notice that naval radar equipment emits microwave-type non-ionizing radiation. Rucker v. Brown, 10 Vet. App. 67 (1997). The veteran also believes he was exposed to ionizing radiation on Guam because of residuals of fallout from nuclear weapons tests and from decontamination of ships in the area of Cocos Island and lagoon and from radioactive material he believes was put in his food while he was on temporary duty on Cocos Island. The veteran emphasizes that he believes dioxin and trichloroethylene (TCE) are of greatest importance as toxic substances, but he also contends that he was exposed to other contaminants including benzene, pesticides, organochlorines, Toluene, volatile organic compounds (VOCs), semi-volatile organic compounds (SVOCs), polynuclear aromatic hydrocarbons (PAHs), polychlorinated biphenyls (PCBs), and other materials. In particular, he has asserted that the toxic chemicals were in the drinking water on Guam. As described earlier, the veteran has submitted many, many documents, which he contends show that he was exposed to herbicide agents (Agent Orange), other toxic chemicals, and ionizing radiation. With regard to in-service incurrence of the disease, the Board notes that there is no record of treatment for DFSP during service or for years following service discharge. The evidence of record clearly indicates that the veteran was first diagnosed with DFSP in 1983, approximately 15 years after his separation from service in 1968. For that reason, there is no evidence of in-service incurrence or disease to satisfy Hickson element (2). Element (2) may, however, be satisfied by a showing of in- service injury, specifically in this case, exposure to ionizing radiation, exposure to an herbicide agent, or exposure to other toxic chemicals. As outlined above, radar does not produce ionizing radiation, and neither Navy nor Department of Defense studies confirm the veteran's contention of his participation in a food experiment involving radioactive material. While the veteran has submitted documents about the presence of radioactive materials on Guam and at Hunters Point at various locations at various times, those documents do not establish that the veteran himself was exposed to ionizing radiation, and the VA Under Secretary for Health has reviewed the record of official military records and has been unable to provide a dose estimate. As discussed earlier, the Navy Surgeon General was requested to review representative evidence presented by the veteran indicating it was plausible that the veteran was exposed to PCBs and carcinogenic PAHs while at Hunters Point and that he was exposed to PCBs, dioxin, and/or 2.4-D while on Guam. In his April 2007 letter, the Navy Surgeon General discussed the evidence and concluded that the veteran was not likely to have been exposed to a herbicide agent as defined in 38 C.F.R. § 3.307(a)(6), specifically: 2,4-D; 2,4,5-T and its contaminant TCDD; cacodylic acid; or picloram during his service. The Navy Surgeon General also concluded that the veteran was not likely to have been exposed to carcinogenic PAHs, PCBs, and/or dioxins (other than TCDD) during is service. There is no other competent evidence of record as to whether the veteran was exposed to a herbicide agent or other toxic chemical in service. Based on the foregoing, the Board finds that the preponderance of the evidence is against finding a corroboration of the veteran's contentions regarding exposure to ionizing radiation, a herbicide agent as defined by 38 C.F.R. § 3.307(a)(6), or other toxic chemical in service. Element (2) in-service incurrence of an injury has therefore not been shown. Further, with respect to the remaining Hickson element, element (3), nexus, there is no indication of competent nexus evidence. At the November 2000 hearing, the veteran testified that he believed that his cancer doctor had told him DFSP was consistent with radiation exposure, but he no longer saw that physician. He also testified that his overall healthcare provider felt that radiation could be the cause of his DFSP but felt it was more than just radiation because of the amount of damage that had been done to him. The veteran was advised that an opinion, in writing, from a doctor setting forth that his DSFP was related to service in some manner would be helpful to his claim and the veteran stated that he understood that. There is, however, no medical opinion in the record that relates the veteran's DFSP to service or any incident of service. While the Board notes that the record includes several entries in VA medical records in which the veteran gives a history of exposure to ionizing radiation, dioxins and other toxic chemicals, in none of those records is there any indication that a health care professional has opined that the veteran's DSFSP is in any way related to service. The sole opinion in support of the veteran's claim consists of his own lay assertions that in-service radiation exposure, herbicide exposure, and/or toxic chemical exposure caused his DFSP. He has not provided any indication that he has training or specialized medical knowledge that would make him competent to render such a medical nexus opinion and such an opinion has no weight of probative value. See Espiritu, 2 Vet. App. At 494-95. The Board recognizes that the duty to assist sometimes includes providing a VA examination/nexus opinion. The Secretary shall treat an examination/nexus opinion as being necessary to make a decision on a claim if the evidence of record before the Secretary, taking into consideration all information and lay or medical evidence (including statements of the claimant) (A) contains competent evidence that the claimant has a current disability, or persistent or recurrent symptoms of disability; and (B) indicates that the disability or symptoms may be associated with the claimant's active military, naval, or air service; but (C) does not contain sufficient medical evidence for the Secretary to make a decision on the claim. 38 U.S.C.A. § 5103A (West 2002). See also McClendon v. Nicholson, 20 Vet. App. 79, 84 (2006). In the Board's November 2006 remand, it was directed that a nexus opinion should be obtained if the claim could not be granted under the provisions of 38 C.F.R. § 3.309(e) and it was determined that it is at least as likely as not that the veteran was exposed to carcinogenic PAHs, PCBs, and/or dioxin (other than TCDD) during service. Because such confirmation was not obtained, the RO properly did not develop the case further. Stegall v. West, 11 Vet. App. 268 (1998). As discussed above, the Board does not find corroboration as to the claimed exposures. The post-service medical evidence, which first shows findings of DFSP many years after service discharge, does not suggest a link to service. Accordingly, the record is sufficient on which to render a decision at this time, and additional other development is not warranted. In summary, the preponderance of the evidence is against service connection for the veteran's DFSP on a direct or presumptive basis. In view of the forgoing, the benefit of the doubt doctrine is not for application, and service connection for DFSP must be denied. See Gilbert v. Derwinski, 1 Vet. App. 49 (1990); Ortiz v. Principi, 274 F. 3d 1361 (Fed. Cir. 2001). ORDER Service connection for dermatofibrosarcoma protuberans of the chest is denied ____________________________________________ M. SABULSKY Veterans Law Judge, Board of Veterans' Appeals Department of Veterans Affairs