Citation Nr: 0812580 Decision Date: 04/16/08 Archive Date: 05/01/08 DOCKET NO. 06-37 789 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in Milwaukee, Wisconsin THE ISSUE Entitlement to service connection for prostate cancer due to in-service exposure to ionizing radiation. REPRESENTATION Appellant represented by: Wisconsin Department of Veterans Affairs WITNESS AT HEARING ON APPEAL The veteran ATTORNEY FOR THE BOARD J. Johnston, Counsel INTRODUCTION The veteran had active military duty from July 1953 to June 1955. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a December 2002 rating decision issued by the Department of Veterans Affairs (VA) Regional Office (RO) in Milwaukee, Wisconsin. The veteran's application for an advance upon the Board's docket was granted in March 2008. The case is now ready for appellate review. FINDINGS OF FACT 1. All relevant evidence necessary for a fair and equitable disposition of the issue on appeal has been requested or obtained. 2. A preponderance of the competent medical and scientific evidence on file is against the veteran's claim that prostate cancer is attributable to exposure to ionizing radiation during service. CONCLUSION OF LAW Prostate cancer was not incurred or aggravated in service, and it may not be presumed to have been so incurred. 38 U.S.C.A. §§ 1101, 1110, 1112, 1113, 1131, 1137, 5102, 103, 5103A, 5107 (West 2002); 38 C.F.R. § § 3.303, 3.307, 3.309, 3.311 (2007). REASONS AND BASES FOR FINDINGS AND CONCLUSION Law and Regulation: VCAA and regulations implementing this liberalizing legislation are applicable to the veteran's claim. VCAA requires VA to notify claimants of the evidence necessary to substantiate their claims, and to make reasonable efforts to assist claimants in obtaining such evidence. The veteran was provided formal VCAA notice in October 2002, prior to the issuance of the initial adverse rating decision now on appeal from December 2002. This notice informed him of the evidence necessary to substantiate his claim, the evidence he was responsible to submit, the evidence VA would collect on his behalf, and advised he submit any relevant evidence in his possession. Additionally, because the veteran claimed to have cancer secondary to in-service radiation exposure, the veteran was provided with a radiation exposure questionnaire for completion and return so that it might be used to assist the veteran in developing evidence necessary to substantiate his claim. The veteran was also provided advice on secondary sources of evidence of exposure to radiation. During the lengthy pendency of this appeal, it is clear that all service medical records, a considerable quantity of private treatment records, and statements from private physicians were collected for review. Additionally, the RO sent the procedurally required inquiry for radiation dose estimate to the Defense Threat Reduction Agency (DTRA) and, in turn, that agency directly contacted the veteran and asked him to assist them by completing a specific radiation questionnaire and to otherwise allow the veteran to participate in the development of background information in providing an accurate dose estimate on his behalf. The DTRA also provided the veteran with information about their nuclear test personnel review, and also provided the veteran with a point of contact for any questions he might have. The DTRA did provide the radiation dose estimate required by law and regulation, and this dose estimate, completed in 2007, was conducted under more newly incorporated methodology for estimating radiation doses made in response to a May 2003 National Research Council (NRC) report concerning radiation dose reconstructions provided to VA by the DTRA. VA fully complied with the procedural guidelines of 38 C.F.R. § 3.311 regarding ionizing radiation claims by obtaining a radiation dose estimate from the Department of Defense, and referring the case to the Director of the VA Compensation and Pension Service who obtained a medical opinion from the Under Secretary for Health. The veteran availed himself of the opportunity of providing testimony at a hearing conducted at the RO. He also provided VA with several evidence packages which included medical evidence, and certain scientific articles specifically focused on prostate cancer and radiation exposure. It is certainly clear the veteran has actual knowledge of the evidence necessary to substantiate his claims in his numerous written statements submitted to VA. Neither the veteran nor his representative has indicated that the veteran has or knows of any additional information which has not been collected for review. The Board finds that VCAA is satisfied in this appeal. 38 U.S.C.A. §§ 5102, 5103, 5103A, 5107; Quartuccio v. Principi, 16 Vet. App. 183 (2002). Service connection may be established for disease or injury incurred or aggravated in line of active military duty. 38 U.S.C.A. § 1110; 38 C.F.R. § 3.303. For certain chronic diseases, including malignant tumors, which become manifest to a degree of 10 percent within one year from the date of service separation, such disease shall be rebuttably presumed to have been incurred or aggravated by such service, notwithstanding there is no evidence of the disease during service. 38 U.S.C.A. §§ 1101, 1112, 1113, 1137; 38 C.F.R. §§ 3.307, 3.309. Service connection may also be granted for any disease diagnosed after discharge, when all of the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d); Cosman v. Principi, 3 Vet. App. 303, 305 (1992). Service connection for diseases claimed as attributable to exposure to ionizing radiation in service can be established in any of three different ways, which have been outlined by the US Court of Appeals for Veterans Claims (Court). Davis v. Brown, 10 Vet. App. 209, 211 (1997); Ruker v. Brown, 10 Vet. App. 67, 71 (1997). First, there are diseases that are presumptively service connected in radiation-exposed veterans under 38 U.S.C.A. § 1112(c) and 38 C.F.R. § 3.309(d). 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 the condition at issue is a radiogenic disease. Third, direct service connection may be established under 38 C.F.R. § 3.303(d) by showing that the disease was in fact incurred during or aggravated by service without regard to statutory presumptions. See Combee v. Brown, 34 Fed. 3d, 1039, 1043-44 (Fed. Cir. 1994). Under Combee, VA must not only determine whether a veteran had a disability recognized by VA as being etiologically related to exposure to ionizing radiation, but must also determine whether the disability was otherwise the result of active service. In other words, the fact that the requirements of a presumptive regulation are not met does not in and of itself preclude a claimant from establishing service connection by way of proof of actual direct causation. There is a list of diseases (including various specified cancers) which may be 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)(2). Prostate cancer is not one of these diseases. There is a list of "radiogenic diseases" at 38 C.F.R. § 3.11 which are recognized as cancers which may be incurred and induced by exposure to ionizing radiation which does include prostate cancer. 38 C.F.R. § 3.311(b)(2). 38 C.F.R. § 3.11(a) calls for the development of a radiation dose estimate where it is established that a radiogenic disease first became manifest after service, and where it did not manifest to a compensable degree within any applicable presumptive period provided in either 38 C.F.R. § 3.307 or 38 C.F.R. § 3.309, and where it is contended that the disease is a result of ionizing radiation exposure during service. Dose data will be requested from the Department of Defense (DTRA) in claims based upon participation in atmospheric nuclear testing. 38 C.F.R. § 3.311(a)(2). After the evidence has been assembled, it is the Board's responsibility to evaluate the entire record. 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, the benefit of the doubt in resolving such issue shall be given to the claimant. 38 U.S.C.A. § 5107; 38 C.F.R. §§ 3.102, 4.3 (2007). To deny a claim on its merits, the preponderance of the evidence must be against the claim. Alemany v. Brown, 9 Vet. App. 518, 519 (1996). Analysis: Initially, the Board would point out that the evidence certainly does not show nor does the veteran contend that he incurred prostate cancer at any time during or to a compensable degree within one year after he was separated from service in 1955. The clinical record on file clearly reveals that prostate cancer was first diagnosed in June 2002, some 47 years after he was separated from service. Subsequent biopsy of the left and right prostate resulted in pathological findings of moderately to poorly differentiated adenocarcinoma, Gleason's Grade 3+ 4 (Score of 7/10). The veteran was treated with Neoadjuvant hormonal therapy with Zoladex, followed by concurrent Zoladex and external beam radiation therapy which ended in May 2003. After completing therapy, the veteran was noted to be feeling well with no signs or symptoms suggestive of progressive or recurrent disease. There were essentially no GI side effects such as chronic diarrhea, hematochezia or tenesmus. There was also little in the way of GU adverse effects, as the veteran denied persistent dysuria, hematuria, hesitancy, incontinence or dribbling. There was stable nocturia of once or twice per night. Subsequent to this time, however, there are notations of again increasing PSA values, but at the time of this decision, there is no report indicating any actual recurrence of prostate cancer as identifiable pathology. Again, there is simply no evidence nor any argument from the veteran that he incurred prostate cancer at any time during or to a compensable degree within one year after he was separated from service. Accordingly, there is no basis for an allowance of service connection for prostate cancer on a direct incurrence theory. The veteran's claim and VA's entire adjudication of that claim is centered around the question of whether the veteran's remote onset of prostate cancer is attributable to in-service ionizing radiation exposure. The evidence on file reveals that the veteran served aboard the USS Munro (DE-422) and that in mid-February 1954, the Munro (with the veteran aboard) was ordered to the Pacific Proving Grounds in the Marshall Islands. An atmospheric nuclear test series designated Castle was scheduled to begin on 1 March 1954. The veteran reports that on the morning of 1 March 1954, the Munro was approximately 300 miles East of Bikini Atoll, at which time a nuclear test weapon designated Castle Bravo was detonated. It is undisputed that this was the largest hydrogen bomb ever exploded by the United States in atmospheric testing. Although some 300 miles distant from the blast, the veteran reported that the morning sky lit up and that his ship was struck with shock waves. It is reported that the Munro then proceeded to Quajalein and two days were spent patrolling South and West of Quajalein. On 3 March 1954, the veteran reported that operational control on Munro was transferred to Joint Task Force 7's Task Group 7.3 and ordered to Utirik Island to assist in removal of its 154 inhabitants because a monitor plane had detected radiation fall-out from the nuclear explosion on that island. The veteran's ship, Munro and another US ship (USS Renshaw) removed the island's inhabitants by 1 PM and both ships departed for Quajalein. The veteran reported that after this time, Munro's water hoses were used to wash down suspected radioactive fall-out to the ship's exterior structure. The objective evidence on file confirms the veteran's reports of service aboard the USS Munro at the time of this nuclear detonation, and although a considerable distance away from that detonation, sufficiently close to both detonation and known fall-out to be considered a radiation-exposed veteran in accordance with the governing laws and regulations. With regard to the veteran's proximity to the actual nuclear detonation, the Board notes that he had earlier applied for benefits under the Radiation Exposure Compensation Act, but was denied because it was determined that he was not an "on sight participant" as defined by the laws and regulations governing benefits under that Act. It is certainly clear that the veteran while serving aboard the USS Munro was not in the immediate proximity of the nuclear detonation, but it is also clear that that detonation resulted in significant fall-out subject to winds and weather in the Pacific Ocean, so the question presented is the degree to which the veteran may have been exposed to such fall-out, and whether such radiation exposure contributed to the onset of his prostate cancer first diagnosed in 2002. The veteran presented certain evidence in support of his claim. This included an advocacy document prepared by a scientific adviser for the National Association of Atomic Veterans to the US Senate in April 1998 which argued that the current dose estimates performed by DOD and relied upon by VA were not accurate. He also submitted an article which concluded that long-term low-dose internal ionizing radiation potentially may cause prostate cancer. Another article discussed a higher incidence of prostatic intraepithelial neoplasia (PIN) in men who underwent surgery for benign prostatic hyperplasia (BPH) before and after the Chernobyl nuclear accident, suggesting that long-term, low-dose internal ionizing radiation potentially may cause prostate cancer. He submitted several other articles which supported a causal connection between cancers of the prostate and exposure to ionizing radiation. The Board would point out that VA certainly does not disagree with any of these studies and articles. Indeed, although prostate cancer is not a cancer recognized by statistical studies which may be presumed by law and regulation to result in any radiation-exposed veteran, VA certainly recognizes that prostate cancer is a "radiogenic disease," meaning a disease that may be induced by ionizing radiation. See 38 C.F.R. § 3.311(b)(2). The question presented in this appeal is not whether ionizing radiation can result in prostate cancer; it can. The question presented is whether the veteran's specific prostate cancer manifested in 2002 was caused by the specific ionizing radiation to which he was exposed during service in 1954. In August 2004, a private assistant professor of medicine wrote that it was unclear to him whether the veteran's prostate cancer resulted from his degree of exposure sustained during his service aboard ship in the proximity of nuclear weapons testing. He wrote that he thought it was "possible." In December 2004, a private doctor of oncology wrote that given that exposure was in 1954, and diagnosis of prostate cancer in 2002, "there is no proven definite causative data of exposure so long ago leading to any cancers at this time." In January 2005, a private medical physicist and associate professor of radiation oncology wrote that the veteran was on duty aboard a ship that passed through areas of fall-out. The ship had not originally been assigned to this task so the veteran had not been issued any radiation monitors to determine actual dosages. He wrote that the exposure concerned would have been from radioactive materials inhaled or ingested and metabolized internally. In 1968, the veteran developed an intestinal carcinoid cancer. Prostate cancer was diagnosed in 2002. He wrote that until very recently, prostate cancer had not been considered a radiogenic disease, but that various studies more recently conducted demonstrated increased incidences of prostate cancer in radiation-exposed individuals. He wrote that radiation in low levels is a weak carcinogen. With the current state of technology, one can never say that any given cancer resulted from a radiation exposure, only the probability of causation. Without knowing the amount of radiation to which the veteran was exposed, assessing the probability that his cancer resulted from exposure "is also not impossible." He wrote that, given the veteran's history and scientific data relating exposure to prostate cancer indication, there was "a good probability" that the veteran's exposure in 1954 "may have caused his cancer or may have contributed to causing his cancer." He also wrote that it was entirely possible that his cancer was due to natural causes. With respect to the veteran's earlier claim for benefits under the Radiation Exposure Compensation Act, the decision on appeal in that case notes that the Defense Nuclear Agency (DNA), as the executive agent of the Department of Defense (DOD), was charged with reconstructing the history of US nuclear testing and maintaining records of the personnel involved in that program. DNA had retrieved and reviewed the USS Munro's deck logs for the period of time from 1 through 8 March 1954. This was the only time the Munro was in the Marshall Islands and the first detonation in the Castle Series known as Shock Bravo occurred on 1 March 1954. The second detonation in the Castle Series (Shock Romeo) did not occur until 27 March 1954, long after the Munro returned to Pearl Harbor. The Munro arrived in the Marshall Islands from Pearl Harbor on 1 March 1954 and operated in the Quajalein area from 1 to 7 March 1954, departing the area to return to Pearl Harbor in the early morning of 7 March. A DNA memorandum analyzing the Munro's potential for exposure to fall-out from Shot Bravo noted that at the time Shot Bravo was detonated (on the morning of 1 March 1954), the Munro was 150 nautical miles East-northeast of Quajalein. She arrived at Quajalein at 1645 hours on 1 March and departed that location at 0700 hours on 2 March. She then took part in the search for a missing airplane until 1845 hours on 3 March; the search took place in an area extending from 200-400 nautical miles South- southwest of Quajalein. At the termination of the search, the Munro was ordered to proceed to Utirik Atoll (located approximately 250 nautical miles Northeast of Quajalein), to assist the USS Renshaw in the evacuation of the native population from the island. The Munro proceeded to Quajalein, arriving there at 0800 hours on March 5, and remained at that location until 0830 hours on 7 March, when she departed for Pearl Harbor. The Munro did not return to the Pacific proving ground during the remainder of the Castle Series. This report further provided that based on Munro's activity sequence, and the fall-out pattern from Shock Bravo, the DNA noted that the Bravo fall-out cloud did not cross the Munro's path while she was en route to Quajalein, that Munro left Quajalein on 2 March before the first traces of fall-out were noted in that location, the Munro's search activities on 2 and 3 March occurred in an area significantly South of the southern edge of Bravo fall-out, peak fall-out levels occurred at Utirik and nearby Atolls at 1200 hours on 2 March (more than 48 hours before the Munro arrived in that area), the Munro never reached Utirik or sent personnel ashore there (when Munro arrived, Renshaw had already completed the Utirik evacuation). The conclusion of DNA was that since Munro was more than 250 nautical miles from the only Castle test conducted while the ship was in the Pacific proving ground, there was no potential for the crew to be exposed to initial radiation, neither neutron or gamma. Further, there was no evidence that Munro encountered radioactive fall-out following any of the Castle tests, hence the crew was not exposed to residual radiation while aboard this ship. The DNA concluded its report on the Munro's presence in the vicinity of Shock Bravo by reporting that the reconstructed fall-out dose for her crew was 0.00 rem. The veteran appealed the initial determination and it was later noted that during its time in the vicinity of Quajalein Atoll, the operational control of Munro was transferred to CTG 7.3 on 3 March, and the subsequent deployment of Munro to assist in evacuation of Utirik Atoll. The remainder of the appealed decision largely centers upon a determination of what was and was not within the "official zone" around the Bikini Atoll test site since it is clear that the actual distribution of fall-out from Shot Bravo exceeded three pre- shot predictions. It was determined that Munro was never present within the boundaries of either pre- or post- Bravo danger zones, although she did traverse to the Southeastern corner of "Area Green" for approximately 12 hours on 4 March 1954. It was later noted that "Area Green" was not created until at least 9 days after the Munro was in the relevant area and, more likely, 19 days after she was there. It was concluded from a detailed review of the activities of the Munro during the week of 1 to 7 March 1954 that the ship did not enter the waters which were ever part of Operation Castle "danger zones" and was at all time far outside the "danger zone" associated with Shock Bravo. The Quasi restricted area (Area Green) to which the Munro traveled on 4 March 1954 was not created until at least a week after the Munro left the Marshall Islands altogether. The Board reports the details of this appealed decision not for its relevance regarding whether or not the veteran qualified for payment of some benefit based upon being considered an "on-sight participant," under the Radiation Exposure Compensation Act, but because it provides the best technical description of the locations of the USS Munro during the relevant periods of Shot Bravo on Bikini Atoll. Finally, and after allowing the veteran to participate in the factual background prior to completion, the DTRA issued its does estimate in March 2007. The DTRA found that the veteran was a confirmed participant of Operation Castle, conducted at the Pacific Proving Ground in 1954. The factual summary provided by the DTRA was largely consistent with that previously discussed and as alleged by the veteran in various written statements. The veteran has subsequently argued that the Munro was "DE 442," not "DDE 442," and he was in fact aware of the detonation as the sky lit up, that the time ashore was more than one to two hours in both events of shore leave, that the USS Munro was assigned to task force 7.3 at 1500 hours, not 1842 hours and that the Renshaw and Munro met close to Utirik Atoll at approximately 1300 hours. The Board finds that this dispute of facts is not significant with respect to the dose estimates supplied by the DTRA. The DTRA dose estimate also noted that at its June 2006 meeting, the Veteran's Advisory Board on Dose Reconstruction recommended a screening process of prostate cancer cases. The expedited process established conservative theoretical maximum doses utilizing actual radiation level measurements and technical calculations from atmospheric nuclear test detonations, previously established prostate doses, bounding assumptions about exposure scenarios, and radiation science fundamentals. These maximum doses "are much higher than doses that were estimated in previous radiation dose assessments, thus providing maximum benefit of the doubt to the veteran and ensuring that the reported doses are not less than actual doses." Reported doses are based on "worse-case parameters and assumptions, not all of which the veteran may have encountered." These parameters and assumptions should adequately encompass any activities that the veteran performed. The DTRA dose estimate was then referred for a medical opinion to the Under Secretary for Health and for review by the Chief Public Health and Environmental Hazards officer for a medical opinion. In September 2007, the doctor issued a report which accurately reported the dose estimates provided by DTRA. Using well-established criteria from the National Institute for Occupational Safety and Health to estimate the likelihood that exposure to ionizing radiation was responsible for the veteran's prostate cancer, the computer software calculated a 99th percentile value for the probability of causation of 22.7 percent. The doctor concluded that in light of this finding, "it is unlikely that the veteran's prostate cancer can be attributed to exposure to ionizing radiation in service." The same month, the Director of the Compensation and Pension Service of VA reviewed the evidence and medical opinion provided and concluded "that there is no reasonable possibility that the veteran's adenocarcinoma of the prostate resulted from radiation exposure in service." The Board finds that a clear preponderance of the evidence on file is against the veteran's claim for service connection for prostate cancer attributable to exposure to ionizing radiation during his service aboard ship in the Pacific in 1954. The Board has carefully evaluated all of the significant and substantial clinical and factual evidence on file in arriving at this decision. The Board notes that a significant amount of evidence and argument submitted by the veteran was aimed at establishing the fact that prostate cancer can be caused by exposure to ionizing radiation. The Board and VA certainly does not dispute this finding, and it is noted in this regard that a governing regulation lists prostate cancer specifically as a radiogenic disease in recognition of this fact. The question presented in this appeal is not whether radiation exposure can cause prostate cancer generally, but whether the veteran's prostate cancer diagnosed in 2002 is at least as likely as not attributable to his exposure to ionizing radiation during his service aboard the USS Munro in the proximity of a nuclear detonation which occurred on Bikini Atoll in March 1954. It is certainly clear and undisputed that the veteran and the USS Munro was not in the immediate proximity of the area of the actual detonation. The factual dispute is whether and to what extent the veteran and the USS Munro traveled through the path of fall-out from that bomb detonation. It is certainly clear from a review of the evidence that every objective effort had been made to make a factual determination as to the extent of possible fall-out exposure which might have affected the Munro and the veteran who is clearly noted as having served above decks during the time period. The does estimate provided by DTRA in March 2007 specifically notes that these estimates include maximum doses which are much higher than those previously provided in estimations, providing maximum benefit of the doubt to the veteran and ensuring that reported doses are not less than actual. A dose estimate provided by DTRA was found by the Chief Public Health and Environmental Hazards officer of VA to be unlikely as a causal or contributing factor in the veteran's prostate cancer and the Director of VA Compensation and Pension Service concluded that there was no reasonable possibility, again based upon these dose estimates, that the veteran's prostate cancer resulted from radiation exposure in service. The Board finds that these opinions outweigh by a significant margin the January 2005 opinion of the veteran's private physician who concluded that there was a "good probability" that the veteran's exposure in 1954 "may have" caused his prostate cancer. This doctor himself wrote that without "knowing the amount of radiation to which [the veteran] was exposed, assessing the probability that his cancer resulted from the exposure is also not impossible." Indeed, this physician did not attempt or indicate that he was even qualified to attempt to provide a dose estimate for the veteran's putative exposure to radiation fall-out in 1954. In the absence of any accurate dose reconstruction estimate, this opinion lacks an essential element of its foundation, and is therefore of less probative value. Indeed, with no dose estimate, the Board finds that this opinion is essentially speculative in nature, and indeed this physician wrote that the veteran's prostate cancer may have been caused by such exposure, but that it was entirely possible that his cancer was due to natural causes. On the other hand, although the data provided by DTRA is only an estimate, it is the best scientifically based evidence available in this case. It is also noted that this estimate includes a computation methodology which results in maximum doses which were much higher than previous radiation dose estimates. And this dose estimate appears to be consistent with the factual investigations previously conducted regarding the actual proximity of the USS Munro to detonation and fall-out from Shot Bravo. Based upon scientifically estimated doses, it was the conclusion of the Chief Public Health and Environmental Hazards officer and Director of VA Compensation and Pension Service that it was unlikely that the veteran's prostate cancer was attributable to exposure to ionizing radiation during service, so a clear preponderance of the evidence is against the claim. The Board notes the veteran's most recent objection to statements included in the record referring to him as a former smoker or tobacco user. The Board concurs with the veteran's allegation that the evidence on file does not reveal the veteran to be a long-term tobacco user during his lifetime, and the Board notes that although perhaps erroneously noted as a former smoker, no medical evidence relied upon by the Board in this decision in any way attributes the veteran's prostate cancer to a previous history of tobacco use or smoking. VA has no duty in this case to decide the most probable cause of the veteran's prostate cancer, only whether it is more, less, or equally likely that prostate cancer is attributable to in-service radiation exposure. Finally, the Board would note that in November 2006, the RO granted service connection for two metastatic carcinoid tumors of the small bowel mesentery and liver, with a prior history of carcinoid cancer of the small bowel with resection, due to ionizing radiation exposure, on the basis that these cancers, unlike prostate cancer, are within the purview of the presumptive provisions of the governing law and regulations. The veteran was provided a 100 percent evaluation for these two metastatic carcinoid tumors, and an associated grant of dependents educational assistance. That 100 percent Schedular evaluation for cancer guarantees the veteran the right to medical treatment for any and all disabilities whether attributable to service or otherwise. ORDER Entitlement to service connection for prostate cancer as a result of exposure to ionizing radiation is denied. ____________________________________________ F. JUDGE FLOWERS Veterans Law Judge, Board of Veterans' Appeals Department of Veterans Affairs