Citation Nr: 0830077 Decision Date: 09/05/08 Archive Date: 09/10/08 DOCKET NO. 04-00 079 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in Phoenix, Arizona THE ISSUES 1. Entitlement to service connection for leukemia as a result of exposure to ionizing radiation. 2. Entitlement to service connection for multiple myeloma as a result of exposure to ionizing radiation. 3. Entitlement to service connection for lymphoma as a result of exposure to ionizing radiation. 4. Entitlement to service connection for cancer of the thyroid as a result of exposure to ionizing radiation. 5. Entitlement to service connection for cancer of the esophagus as a result of exposure to ionizing radiation. 6. Entitlement to service connection for cancer of the liver as a result of exposure to ionizing radiation. 7. Entitlement to service connection for cancer of the lungs as a result of exposure to ionizing radiation. 8. Entitlement to service connection for cancer of the urinary bladder as a result of exposure to ionizing radiation. 9. Entitlement to service connection for cancer of the colon as a result of exposure to ionizing radiation. 10. Entitlement to service connection for cancer of the stomach as a result of exposure to ionizing radiation. 11. Entitlement to service connection for cancer of the pharynx as a result of exposure to ionizing radiation. 12. Entitlement to service connection for cancer of the small intestines as a result of exposure to ionizing radiation. 13. Entitlement to service connection for cancer of the pancreas as a result of exposure to ionizing radiation. 14. Entitlement to service connection for cancer of the male breast as a result of exposure to ionizing radiation. 15. Entitlement to service connection for cancer of the bile ducts as a result of exposure to ionizing radiation. 16. Entitlement to service connection for cancer of the gallbladder as a result of exposure to ionizing radiation. 17. Entitlement to service connection for cancer of the salivary gland as a result of exposure to ionizing radiation. 18. Entitlement to service connection for cancer of the brain as a result of exposure to ionizing radiation. 19. Entitlement to service connection for type 2 diabetes mellitus as a result of exposure to ionizing radiation. 20. Entitlement to service connection for hypertension as a result of exposure to ionizing radiation. 21. Entitlement to service connection for vision loss as a result of exposure to ionizing radiation. 22. Entitlement to service connection for headaches as a result of exposure to ionizing radiation. 23. Entitlement to service connection for bilateral hearing loss as a result of exposure to ionizing radiation. REPRESENTATION Appellant represented by: Arizona Department of Veterans Services WITNESSES AT HEARING ON APPEAL Appellant and his son ATTORNEY FOR THE BOARD Amy R. Grasman, Associate Counsel INTRODUCTION The veteran served on active duty from July 1955 to November 1958. This appeal comes before the Board of Veterans' Appeals (Board) from June 2003 and July 2003 rating decisions issued by the Department of Veterans Affairs (VA) Regional Office (RO) in Phoenix, Arizona. The Board notes that the veteran's original claim included a claim for service connection for squamous cell carcinoma of the left forearm. Service connection for this issue was granted in a March 2008 rating decision. In April 2008, the veteran testified in a Travel Board hearing in front of the undersigned Veterans Law Judge. The transcript of the hearing is associated with the claims file and has been reviewed. Based on a motion presented during the hearing, this appeal was advanced on the docket. 38 U.S.C.A. § 7107(a) (West 2002); 38 C.F.R. § 20.900(c) (2007). Unfortunately, the veteran's claims file was not immediately transferred to the Board after the hearing. The Board apologizes for the delay in the adjudication of this claim. The Board also received additional evidence from the veteran during the April 2008 hearing. The evidence was accompanied by a waiver of the veteran's right to initial consideration of the new evidence by the RO. 38 C.F.R. §§ 19.9, 20.1304(c) (2007). Accordingly, the Board will consider the new evidence in the first instance in conjunction with the issues on appeal. The issue of entitlement to service connection for hearing loss is addressed in the REMAND portion of the decision below and is REMANDED to the RO via the Appeals Management Center (AMC), in Washington, DC. FINDINGS OF FACT 1. The competent medical evidence does not show a current diagnosis of leukemia. 2. The competent medical evidence does not show a current diagnosis of multiple myeloma. 3. The competent medical evidence does not show a current diagnosis of lymphoma. 4. The competent medical evidence does not show a current diagnosis of cancer of the thyroid. 5. The competent medical evidence does not show a current diagnosis of cancer of the esophagus. 6. The competent medical evidence does not show a current diagnosis of cancer of the liver. 7. The competent medical evidence does not show a current diagnosis of cancer of the lungs. 8. The competent medical evidence does not show a current diagnosis of cancer of the urinary bladder. 9. The competent medical evidence does not show a current diagnosis of cancer of the colon. 10. The competent medical evidence does not show a current diagnosis of cancer of the stomach. 11. The competent medical evidence does not show a current diagnosis of cancer of the pharynx. 12. The competent medical evidence does not show a current diagnosis of cancer of the small intestines. 13. The competent medical evidence does not show a current diagnosis of cancer of the pancreas. 14. The competent medical evidence does not show a current diagnosis of cancer of the male breast. 15. The competent medical evidence does not show a current diagnosis of cancer of the bile ducts. 16. The competent medical evidence does not show a current diagnosis of cancer of the gallbladder. 17. The competent medical evidence does not show a current diagnosis of cancer of the salivary gland. 18. The competent medical evidence does not show a current diagnosis of cancer of the brain. 19. The competent medical evidence does not show that diabetes mellitus Type 2 manifested in service, within one year after service or is related to service, including radiation exposure in service. 20. The competent medical evidence does not show that hypertension manifested in service, within one year after service or is related to service, including radiation exposure in service. 21. The competent medical evidence does not show a current disability manifested by vision loss. 22. The competent medical evidence does not show a current disability manifested by headaches. CONCLUSIONS OF LAW 1. Leukemia was not incurred in or aggravated by service. 38 U.S.C.A. § 1131 (West 2002); 38 C.F.R. §§ 3.303, 3.309(d), 3.311 (2007). 2. Multiple myeloma was not incurred in or aggravated by service. 38 U.S.C.A. § 1131 (West 2002); 38 C.F.R. §§ 3.303, 3.309(d), 3.311 (2007). 3. Lymphoma was not incurred in or aggravated by service. 38 U.S.C.A. § 1131 (West 2002); 38 C.F.R. §§ 3.303, 3.309(d), 3.311 (2007). 4. Cancer of the thyroid was not incurred in or aggravated by service. 38 U.S.C.A. § 1131 (West 2002); 38 C.F.R. §§ 3.303, 3.309(d), 3.311 (2007). 5. Cancer of the esophagus was not incurred in or aggravated by service. 38 U.S.C.A. § 1131 (West 2002); 38 C.F.R. §§ 3.303, 3.309(d), 3.311 (2007). 6. Cancer of the liver was not incurred in or aggravated by service. 38 U.S.C.A. § 1131 (West 2002); 38 C.F.R. §§ 3.303, 3.309(d), 3.311 (2007). 7. Cancer of the lungs was not incurred in or aggravated by service. 38 U.S.C.A. § 1131 (West 2002); 38 C.F.R. §§ 3.303, 3.309(d), 3.311 (2007). 8. Cancer of the urinary bladder was not incurred in or aggravated by service. 38 U.S.C.A. § 1131 (West 2002); 38 C.F.R. §§ 3.303, 3.309(d), 3.311 (2007). 9. Cancer of the colon was not incurred in or aggravated by service. 38 U.S.C.A. § 1131 (West 2002); 38 C.F.R. §§ 3.303, 3.309(d), 3.311 (2007). 10. Cancer of the stomach was not incurred in or aggravated by service. 38 U.S.C.A. § 1131 (West 2002); 38 C.F.R. §§ 3.303, 3.309(d), 3.311 (2007). 11. Cancer of the pharynx was not incurred in or aggravated by service. 38 U.S.C.A. § 1131 (West 2002); 38 C.F.R. §§ 3.303, 3.309(d), 3.311 (2007). 12. Cancer of the small intestines was not incurred in or aggravated by service. 38 U.S.C.A. § 1131 (West 2002); 38 C.F.R. §§ 3.303, 3.309(d), 3.311 (2007). 13. Cancer of the pancreas was not incurred in or aggravated by service. 38 U.S.C.A. § 1131 (West 2002); 38 C.F.R. §§ 3.303, 3.309(d), 3.311 (2007). 14. Cancer of the male breast was not incurred in or aggravated by service. 38 U.S.C.A. § 1131 (West 2002); 38 C.F.R. §§ 3.303, 3.309(d), 3.311 (2007). 15. Cancer of the bile ducts was not incurred in or aggravated by service. 38 U.S.C.A. § 1131 (West 2002); 38 C.F.R. §§ 3.303, 3.309(d), 3.311 (2007). 16. Cancer of the gallbladder was not incurred in or aggravated by service. 38 U.S.C.A. § 1131 (West 2002); 38 C.F.R. §§ 3.303, 3.309(d), 3.311 (2007). 17. Cancer of the salivary gland was not incurred in or aggravated by service. 38 U.S.C.A. § 1131 (West 2002); 38 C.F.R. §§ 3.303, 3.309(d), 3.311 (2007). 18. Cancer of the brain was not incurred in or aggravated by service. 38 U.S.C.A. § 1131 (West 2002); 38 C.F.R. §§ 3.303, 3.309(d), 3.311 (2007). 19. Diabetes mellitus was not incurred in or aggravated by service and may not be presumed to have been incurred in service. 38 U.S.C.A. §§ 1131, 1112, 1116 (West 2002 and Supp. 2007); 38 C.F.R. §§ 3.303, 3.307, 3.309 (2007). 20. Hypertension was not incurred in or aggravated by service and may not be presumed to have been incurred in service. 38 U.S.C.A. §§ 1131, 1112, 1116 (West 2002 and Supp. 2007); 38 C.F.R. §§ 3.303, 3.307, 3.309 (2007). 21. Vision loss was not incurred in or aggravated by service. 38 U.S.C.A. § 1131 (West 2002); 38 C.F.R. § 3.303 (2007). 22. Headaches were not incurred in or aggravated by service. 38 U.S.C.A. § 1131 (West 2002); 38 C.F.R. § 3.303 (2007). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS As provided for by the Veterans Claims Assistance Act of 2000 (VCAA), the VA has a duty to notify and assist claimants in substantiating a claim for VA benefits. 38 U.S.C.A. §§ 5100, 5102, 5103, 5103A, 5107, 5126 (West 2002 & Supp. 2007); 38 C.F.R. §§ 3.102, 3.156(a), 3.159 and 3.326(a) (2007). Upon receipt of a complete or substantially complete application for benefits, VA is required to notify the claimant and his 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 from VA must inform the claimant of any information and evidence not of record (1) that is necessary to substantiate the claim; (2) that VA will seek to provide; and (3) that the claimant is expected to provide. 38 C.F.R. § 3.159(b)(1). This notice must be provided prior to an initial unfavorable decision on a claim by the agency of original jurisdiction (AOJ). Mayfield v. Nicholson, 444 F.3d 1328 (Fed. Cir. 2006); Pelegrini v. Principi, 18 Vet. App. 112 (2004). Here, the VCAA duty to notify was satisfied by way of a letter sent to the appellant in July 2002 that fully addressed all notice elements and was sent prior to the initial AOJ decision in this matter. Supplemental letters were also sent in September 2002, and July 2004. The letters informed the appellant of what evidence was required to substantiate the claims and of the appellant's and VA's respective duties for obtaining evidence. The appellant was also asked to submit evidence and/or information in his possession to the AOJ. In Dingess v. Nicholson, 19 Vet. App. 473 (2006), the U.S. Court of Appeals for Veterans Claims held that, upon receipt of an application for a service-connection claim, 38 U.S.C. § 5103(a) and 38 C.F.R. § 3.159(b) require VA to review the information and the evidence presented with the claim and to provide the claimant with notice of what information and evidence not previously provided, if any, will assist in substantiating, or is necessary to substantiate, each of the five elements of the claim, including notice of what is required to establish service connection and that a disability rating and an effective date for the award of benefits will be assigned if service connection is awarded. In this case, the veteran was provided with this notice in March 2006. Any error regarding this notice was harmless given that service connection is being denied, and hence no rating or effective date will be assigned with respect to the claimed conditions. VA also has a duty to assist the veteran in the development of the claim. This duty includes assisting the veteran in the procurement of service medical records and pertinent treatment records and providing an examination when necessary. 38 U.S.C.A. § 5103A; 38 C.F.R. § 3.159. The Board finds that all necessary development has been accomplished, except regarding the claim for service connection for hearing loss as described in the remand portion of this decision, and therefore appellate review may proceed without prejudice to the appellant. See Bernard v. Brown, 4 Vet. App. 384 (1993). The RO has obtained service medical records, DD Form 214, private medical records and VA medical records. The veteran was provided an opportunity to set forth his contentions during the hearing before the undersigned Veterans Law Judge. In determining whether the duty to assist requires that a VA medical examination be provided or medical opinion obtained with respect to a veteran's claim for benefits, there are four factors for consideration. These four factors are: (1) whether there is competent evidence of a current disability or persistent or recurrent symptoms of a disability; (2) whether there is evidence establishing that an event, injury, or disease occurred in service, or evidence establishing certain diseases manifesting during an applicable presumption period; (3) whether there is an indication that the disability or symptoms may be associated with the veteran's service or with another service-connected disability; and (4) whether there otherwise is sufficient competent medical evidence of record to make a decision on the claim. 38 U.S.C. § 5103A(d) and 38 C.F.R. § 3.159(c)(4). The appellant was afforded a VA medical examination in January 2003 regarding his claims for various cancers. Regarding his claims for service connection for diabetes, hypertension, vision loss, and headaches, the service medical records do not indicate chronic disabilities. He had complaints of headaches on one occasion in service; however he was diagnosed with influenza. No chronic disability was noted at the separation examination. Additionally, the objective medical evidence of record does not show vision loss or headaches after service. In view of the objective evidence of record, the Board finds the veteran's current assertions alone in the face of this objective do not require VA to provide an examination. See Caluza v. Brown, 7 Vet. App. 498, 511 (1995) aff'd, 78 F.3d 604 (Fed. Cir. 1996) (in determining whether lay evidence is satisfactory the Board may properly consider internal consistency, facial plausibility, and consistency with other evidence submitted on behalf of the veteran). The Court has held, in circumstances similar to this, where the supporting evidence of record consists only of a lay statement, that VA is not obligated, pursuant to 5103A(d), to provide a veteran with a medical nexus opinion. See Duenas v. Principi, 18 Vet. App. 512, 519 (2004) (a medical opinion was not warranted when there was no reasonable possibility that such an opinion could substantiate the veteran's claim because there was no evidence, other than his own lay assertion, that reflected an injury or disease in service that may be associated with his symptoms). Significantly, neither the appellant nor his representative has identified, and the record does not otherwise indicate, any additional existing evidence that is necessary for a fair adjudication of the claim that has not been obtained. Hence, no further notice or assistance to the appellant is required to fulfill VA's duty to assist the appellant in the development of the claim. Smith v. Gober, 14 Vet. App. 227 (2000), aff'd 281 F.3d 1384 (Fed. Cir. 2002); Dela Cruz v. Principi, 15 Vet. App. 143 (2001); see also Quartuccio v. Principi, 16 Vet. App. 183 (2002). Service connection may be granted for a disability resulting from a disease or injury incurred in or aggravated by service. 38 U.S.C.A. § 1131; 38 C.F.R. § 3.303(a). This may be shown by affirmative evidence showing inception or aggravation during service or through statutory presumptions. Id. To establish direct service connection for a claimed disorder, there must be (1) medical evidence of current disability; (2) medical, or in certain circumstances, lay evidence of in-service occurrence or aggravation of a disease or injury; and (3) medical evidence of a nexus between the claimed in-service disease or injury and the current disability. See Hickson v. West, 12 Vet. App. 247, 253 (1999); see also Degmetich v. Brown, 104 F.3d 1328 (Fed. Cir. 1997); Brammer v. Derwinski, 3 Vet. App. 223 (1992). For the showing of chronic disease in service there is required a combination of manifestations sufficient to identify the disease entity, and sufficient observation to establish chronicity at the time. See 38 C.F.R. § 3.303(b). If chronicity in service is not established, a showing of continuity of symptoms after discharge is required to support the claim. Id. Service connection may be granted for any disease diagnosed after discharge, when all the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d). Cancers The veteran claims service connection for leukemia, multiple myeloma, lymphoma, cancer of the thyroid, cancer of the esophagus, cancer of the liver, cancer of the lungs, cancer of the urinary bladder, cancer of the colon, cancer of the stomach, cancer of the pharynx, cancer of the small intestines, cancer of the pancreas, cancer of the male breast, cancer of the bile ducts, cancer of the gallbladder, cancer of the salivary gland and cancer of the brain (collectively referred to as "cancers") due to exposure to ionizing radiation in service. Service connection for a disability that is claimed to be attributable to exposure to ionizing radiation during service can be demonstrated by three different methods. See Davis v. Brown, 10 Vet. App. 209, 211 (1997); Rucker v. Brown, 10 Vet. App. 67, 71 (1997). First, there are certain types of cancer that are presumptively service connected specific to radiation-exposed veterans. 38 U.S.C.A. § 1112(c); 38 C.F.R. § 3.309(d). Second, "radiogenic diseases" may be service connected pursuant to 38 C.F.R. § 3.311. Third, service connection may be granted under 38 C.F.R. § 3.303(d) when it is established that the disease diagnosed after discharge is the result of exposure to ionizing radiation during active service. Combee v. Brown, 34 F.3d 1039 (Fed. Cir. 1994). First, a "radiation-exposed veteran" is defined by 38 C.F.R. § 3.309(d)(3) as a veteran who, while serving on active duty, participated in a radiation-risk activity. "Radiation-risk activity" is defined to mean on site participation in a test involving the atmospheric detonation of a nuclear device. 38 C.F.R. § 3.309(d)(3)(i), (ii). In this case, the service records indicate that the veteran participated in Operation Hardtack at Eniwetok Proving Grounds in the Marshall Islands in the spring and summer 1958. The Defense Threat Reduction Agency (DTRA) determined in a letter dated in December 2007 that the total skin dose to any area (beta + gamma) was 550 rem. Therefore, the Board finds that the veteran is a radiation-exposed veteran. Diseases specific to radiation-exposed veterans are the following: leukemia (other than chronic lymphocytic leukemia), thyroid cancer, breast cancer, cancer of the pharynx, esophageal cancer, stomach cancer, cancer of the small intestine, pancreatic cancer, 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), salivary gland cancer, cancer of the urinary tract, bronchio-alveolar carcinoma, bone cancer, brain cancer, colon cancer, lung cancer, and ovarian cancer. 38 C.F.R. § 3.309(d)(2). Second, 38 C.F.R. § 3.311 provides instruction on the development of claims based on exposure to ionizing radiation. Section 3.311(a) calls for the development of a 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 § 3.307 or § 3.309, and where it is contended that the disease is a result of ionizing radiation in service. Pursuant to 38 C.F.R. § 3.311, "radiogenic disease" is defined as a disease that may be induced by ionizing radiation, and specifically includes the following: all forms of leukemia, except chronic lymphocytic leukemia; thyroid cancer, breast cancer, lung cancer, bone cancer, liver cancer, skin cancer, esophageal cancer, stomach cancer, colon cancer, pancreatic cancer, kidney cancer, urinary bladder cancer, salivary gland cancer, multiple myeloma, posterior subcapsular cataracts, non-malignant thyroid nodular disease, ovarian cancer, parathyroid adenoma, tumors of the brain and central nervous system, cancer of the rectum, lymphomas other than Hodgkin's disease, prostate cancer, and any other cancer. 38 C.F.R. § 3.311(b)(2)(i)-(xxiv). Finally, and notwithstanding the above, the United States Court of Appeals for the Federal Circuit (Court) has held that when a veteran is found not to be entitled to a regulatory presumption of service connection for a given disability, the claim must nevertheless be reviewed to determine whether service connection can be established on a direct basis. See Combee, 34 F.3d at 1043-1044. Thus, the Board must not only determine whether the veteran has a disability which is recognized by VA as being etiologically related to exposure to ionizing radiation, but must also determine whether his disability is otherwise the result of active service. In other words, the fact that the veteran may not meet the requirements of a presumptive regulation would not in and of itself preclude him from establishing service connection as he may, in the alternative, establish service connection by way of proof of actual direct causation. In this case, however, the medical evidence does not show that the veteran has been diagnosed with leukemia , multiple myeloma, lymphoma, cancer of the thyroid, cancer of the esophagus, cancer of the liver, cancer of the lungs, cancer of the urinary bladder, cancer of the colon, cancer of the stomach, cancer of the pharynx, cancer of the small intestines, cancer of the pancreas, cancer of the male breast, cancer of the bile ducts, cancer of the gallbladder, cancer of the salivary gland or cancer of the brain. The January 2003 VA Compensation and Pension Examination shows that the veteran does not have current diagnoses of these cancers. There is no other medical evidence of record showing diagnoses of these diseases. The veteran also testified in the April 2008 hearing that he has not been diagnosed with cancer, except squamous cell carcinoma for which he is service connected. As the veteran has not been diagnosed with a disease specific to radiation-exposed veterans, or a "radiogenic disease," service connected cannot be presumed. See 38 U.S.C.A. § 1112(c); 38 C.F.R. §§ 3.309(d), 3.311. Additionally, direct service connection cannot be granted for these disabilities because there is no current diagnosis of a disability. See 38 U.S.C.A. § 1131; 38 C.F.R. § 3.303(a). Furthermore, there was no evidence in the service medical records of these cancers. The July 1955 and November 1958 in-service examinations do not show complaints of, treatment for, or diagnoses of these diseases in service. There is also no nexus between the cancers and service. The January 2003 VA Compensation and Pension Examination does not link any of the previously mentioned cancers or disabilities to service. There is no other medical evidence of records linking the aforementioned diseases to service. The Board has considered the veteran's contention that he is entitled to service connection for these cancers. However, as a layman, without the appropriate medical training and expertise, he is not competent to provide a probative opinion on a medical matter such as a diagnosis or etiology of a disease. While a layman such as the veteran can certainly attest to his in-service experiences and current symptoms, he is not competent to provide a diagnosis. See Bostain v. West, 11 Vet. App. 124, 127 (1998), citing Espiritu v. Derwinski, 2 Vet. App. 492 (1992). See also Routen v. Brown, 10 Vet. App. 183, 186 (1997) ("a layperson is generally not capable of opining on matters requiring medical knowledge"). As the preponderance of the evidence is against the claims for cancers because there are no diagnoses, the benefit-of- the-doubt rule does not apply and the veteran's claim for service connection for leukemia, multiple myeloma, lymphoma, cancer of the thyroid, cancer of the esophagus, cancer of the liver, cancer of the lungs, cancer of the urinary bladder, cancer of the colon, cancer of the stomach, cancer of the pharynx, cancer of the small intestines, cancer of the pancreas, cancer of the male breast, cancer of the bile ducts, cancer of the gallbladder, cancer of the salivary gland and cancer of the brain must be denied. See 38 U.S.C.A. § 5107(b); 38 C.F.R. § 3.102; Gilbert v. Derwinski, 1 Vet. App. 49, 55 (1990). Diabetes Mellitus and Hypertension The veteran has current diagnoses of diabetes mellitus and hypertension. The VA medical records show ongoing treatment for diabetes mellitus Type 2 and hypertension. Where a veteran served 90 days or more during a period of war or during peacetime service after December 31, 1946, and chronic diseases such as diabetes mellitus and hypertension manifest to a degree of 10 percent within one year from date of termination of such service, such disease shall be presumed to have been incurred in service, even though there is no evidence of such disease during the period of service. This presumption is rebuttable by affirmative evidence to the contrary. 38 U.S.C.A. § 1101, 1112, 1113, 1137 (West 2002); 38 C.F.R. §§ 3.307, 3.309. The medical evidence of record does not show that the veteran was diagnosed with diabetes mellitus or hypertension within one year after service. The evidence of record also does not show continuity of symptoms of hypertension or diabetes since service. Therefore, service connection cannot be presumed for a chronic disease. The Board notes that diabetes mellitus and hypertension are also not diseases specific to radiation-exposed veterans under 38 C.F.R. §§ 3.309(d). Diabetes mellitus and hypertension are also not considered "radiogenic diseases" under 38 C.F.R. §§ 3.311. Therefore, service connection cannot be presumed as due to radiation exposure in service. Regarding direct service connection, the service medical records do not show treatment for symptoms of diabetes or hypertension. The July 1955 and November 1958 in-service examinations clinically evaluated the veteran as normal in all areas of examination. There were no complaints or symptoms of hypertension or diabetes in the service medical records. Additionally, the competent medical evidence of record does not show that diabetes mellitus or hypertension is related to service. No doctor has ever opined that diabetes or hypertension was related to any remote incident in service. Without competent medical evidence linking the veteran's disability to service, service connection is not warranted. The Board has also considered the contentions of the veteran that his claimed disabilities should be service connected. However, as a layman, without the appropriate medical training and expertise, he is not competent to provide a probative opinion on a medical matter such as etiology. While a layman such as the veteran can certainly attest to his in-service experiences and current symptoms, he is not competent to provide an opinion relating that disability to service. See Bostain v. West, 11 Vet. App. 124, 127 (1998), citing Espiritu v. Derwinski, 2 Vet. App. 492 (1992). See also Routen v. Brown, 10 Vet. App. 183, 186 (1997) ("a layperson is generally not capable of opining on matters requiring medical knowledge"). As the preponderance of the evidence is against the claims, the benefit-of-the-doubt rule does not apply and the veteran's claim for service connection for diabetes mellitus and hypertension must be denied. See 38 U.S.C.A. § 5107(b); 38 C.F.R. § 3.102; Gilbert v. Derwinski, 1 Vet. App. 49, 55 (1990). Vision Loss and Headaches The veteran claims he has loss of vision and headaches because of radiation exposure in service. The medical evidence of record, however, does not show that the veteran has vision loss or a disability manifested by headaches. There is no diagnosis of or treatment for vision loss in the VA treatment records. The VA treatment records also do not show treatment for headaches. Without a current diagnosis of vision loss or headaches, service connection cannot be granted. Additionally, neither vision loss or headaches are associated with radiation exposure. See 38 C.F.R. § 3.309, 3.311. The Board has considered the contentions of the veteran that he has vision loss and headaches that were caused by service The veteran, however, has not demonstrated that he has any medical expertise to make such an opinion or diagnoses. See Espiritu, supra. Where the determinative issue involves a medical diagnosis, there must be competent medical evidence to the effect that the claim is plausible; lay assertions of medical status do not constitute competent medical evidence. Id. The Board notes that while the veteran is competent to report symptoms, he does not have medical expertise and therefore cannot provide a competent opinion regarding diagnosis or causation of his disabilities. As the medical evidence of record lacks a diagnosis of vision loss or headaches, the preponderance of the evidence is against the veteran's claims and the benefit-of-the-doubt rule does not apply. Therefore, the veteran's claims for service connection for vision loss and headaches must be denied. See 38 U.S.C.A §5107; 38 C.F.R. § 3.102. ORDER Service connection for leukemia as a result of exposure to ionizing radiation is denied. Service connection for multiple myeloma as a result of exposure to ionizing radiation is denied. Service connection for lymphoma as a result of exposure to ionizing radiation is denied. Service connection for cancer of the thyroid as a result of exposure to ionizing radiation is denied. Service connection for cancer of the esophagus as a result of exposure to ionizing radiation is denied. Service connection for cancer of the liver as a result of exposure to ionizing radiation is denied. Service connection for cancer of the lungs as a result of exposure to ionizing radiation is denied. Service connection for cancer of the urinary bladder as a result of exposure to ionizing radiation is denied. Service connection for cancer of the colon as a result of exposure to ionizing radiation is denied. Service connection for cancer of the stomach as a result of exposure to ionizing radiation is denied. Service connection for cancer of the pharynx as a result of exposure to ionizing radiation is denied. Service connection for cancer of the small intestines as a result of exposure to ionizing radiation is denied. Service connection for cancer of the pancreas as a result of exposure to ionizing radiation is denied. Service connection for cancer of the male breast as a result of exposure to ionizing radiation is denied. Service connection for cancer of the bile ducts as a result of exposure to ionizing radiation is denied. Service connection for cancer of the gallbladder as a result of exposure to ionizing radiation is denied. Service connection for cancer of the salivary gland as a result of exposure to ionizing radiation is denied. Service connection for cancer of the brain as a result of exposure to ionizing radiation is denied. Service connection for type 2 diabetes mellitus as a result of exposure to ionizing radiation is denied. Service connection for hypertension as a result of exposure to ionizing radiation is denied. Service connection for vision loss as a result of exposure to ionizing radiation is denied. Service connection for headaches as a result of exposure to ionizing radiation is denied. REMAND The veteran claims that acoustic trauma and/or radiation exposure in service caused his bilateral hearing loss. A private audiological examination in June 2003 shows that the veteran has a current bilateral hearing loss disability. The service records show that the veteran was aboard the USS M.W. Wood (DDR-715) and the USS Monticello (LSD-35). His military occupational specialty was assembler. The veteran was involved in Operation Hardtack at Eniwetok Proving Grounds in the Marshall Islands in the spring and summer 1958. The veteran testified that he was not given hearing protection in service during the atomic explosions. The veteran testified that he witnessed 34 atomic bombs. As there is a current hearing loss disability and evidence of possible acoustic trauma in service, the Board finds that a VA examination is warranted to determine the etiology of the veteran's hearing loss. See 38 U.S.C. § 5103A(d) and 38 C.F.R. § 3.159(c)(4); McLendon v. Nicholson, 20 Vet. App. 79 (2006). Accordingly, the case is REMANDED for the following action: (Please note, this appeal has been advanced on the Board's docket pursuant to 38 C.F.R. § 20.900(c) (2007). Expedited handling is requested.) 1. The veteran should be scheduled for a VA examination with the appropriate medical specialists to determine the nature and etiology of the bilateral hearing loss. The claims file must be made available to and reviewed by the specialist in conjunction with the examination, and the examination report should reflect that such a review was made. All pertinent symptomatology and findings should be reported in detail. Any indicated diagnostic tests and studies should be accomplished. The specialist should state whether the veteran's bilateral hearing loss is more likely than not (i.e., probability greater than 50 percent), at least as likely as not (i.e., probability of 50 percent), or less likely than not (i.e., probability less than 50 percent), causally or etiologically related to or aggravated by service. 2. The RO should then readjudicate the issue on appeal. If the determination remains unfavorable to the veteran, the RO should issue a supplemental statement of the case that contains notice of all relevant actions taken, including a summary of the evidence and applicable law and regulations considered pertinent to the issue. An appropriate period of time should be allowed for response by the veteran and his representative. Thereafter, the case should be returned to the Board for further appellate consideration, if in order. The appellant has the right to submit additional evidence and argument on the matter or matters the Board has remanded. Kutscherousky v. West, 12 Vet. App. 369 (1999). This claim must be afforded expeditious treatment. The law requires that all claims that are remanded by the Board of Veterans' Appeals or by the United States Court of Appeals for Veterans Claims for additional development or other appropriate action must be handled in an expeditious manner. See 38 U.S.C.A. §§ 5109B, 7112 (West Supp. 2008). ____________________________________________ John E. Ormond, Jr. Veterans Law Judge, Board of Veterans' Appeals Department of Veterans Affairs