Citation Nr: 0945423 Decision Date: 11/30/09 Archive Date: 12/04/09 DOCKET NO. 06-35 492 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in Fort Harrison, Montana THE ISSUES 1. Entitlement to service connection for chronic lymphocytic leukemia. 2. Entitlement to service connection for hepatitis C. WITNESS AT HEARING ON APPEAL Appellant ATTORNEY FOR THE BOARD B.W. Hennings, Associate Counsel INTRODUCTION The Veteran served on active duty from October 1970 to December 1979. This matter comes before the Board of Veterans' Appeals (Board) on appeal from August 2005 and April 2006 rating decisions of the Department of Veterans Affairs (VA) Regional Office (RO) in Fort Harrison, Montana. This case was remanded by the Board in May 2009 to afford the Veteran a personal hearing. The Veteran presented testimony at a Travel Board hearing chaired by the undersigned Acting Veterans Law Judge in August 2009. A transcript of this hearing is associated with the Veteran's claims folder. FINDINGS OF FACT 1. The Veteran was not exposed to asbestos during active service. 2. The Veteran was not exposed to herbicides during active service. 3. The competent evidence of record does not support a finding that a relationship exists between the Veteran's currently diagnosed chronic lymphocytic leukemia and his military service. 4. The competent evidence of record does not support a finding that a relationship exists between the Veteran's currently diagnosed hepatitis C and his military service. CONCLUSIONS OF LAW 1. Chronic lymphocytic leukemia was not incurred in or aggravated by active military service, and such may not be so presumed. 38 U.S.C.A. §§ 1110, 1112, 1113, 1116, 1131, 5103, 5103A, 5107 (West 2002 & Supp. 2009); 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309 (2009). 2. Hepatitis C was not incurred in or aggravated by active military service. 38 U.S.C.A. §§ 105, 1110, 1116, 1131, 5103, 5103A, 5107 (West 2002 & Supp. 2009); 38 C.F.R. §§ 3.102, 3.303, 3.307 (2009). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS I. Duties to Notify and to Assist VA's duties to notify and assist claimants in substantiating a claim for VA benefits are found at 38 U.S.C.A. §§ 5100, 5102, 5103, 5103A, 5107, 5126 (West 2002 & Supp. 2009); 38 C.F.R. §§ 3.102, 3.156(a), 3.159 and 3.326(a) (2009). 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) (West 2002 & Supp. 2009); 38 C.F.R. § 3.159(b) (2009); Quartuccio v. Principi, 16 Vet. App. 183 (2002). Formerly, the elements of proper notice included informing 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; (3) that the claimant is expected to provide; and (4) must ask the claimant to provide any evidence in her or his possession that pertains to the claim in accordance with 38 C.F.R. § 3.159(b)(1). Section 3.159 was amended, effective May 30, 2008 as to applications for benefits pending before VA or filed thereafter, to eliminate the requirement that VA will request the claimant to provide any evidence in the claimant's possession that pertains to the claim. 38 C.F.R. § 3.159 (2009). Notice should be provided to a claimant before the initial unfavorable agency of original jurisdiction (AOJ) decision on a claim. Pelegrini v. Principi, 18 Vet. App. 112 (2004); see also Mayfield v. Nicholson, 19 Vet. App. 103 (2005). The notice requirements of 38 U.S.C. § 5103(a) and 38 C.F.R. § 3.159(b) apply to all five elements of a "service connection" claim, defined to include: (1) Veteran status; (2) existence of a disability; (3) a connection between the Veteran's service and the disability; (4) degree of disability; and (5) effective date of the disability. See Dingess v. Nicholson, 19 Vet. App. 473 (2006). However, insufficiency in the timing or content of VCAA notice is harmless if the errors are not prejudicial to the claimant. Conway v. Principi, 353 F.3d 1369, 1374 (Fed. Cir. 2004) (VCAA notice errors are reviewed under a prejudicial error rule); see also Shinseki v. Sanders, 129 S.Ct. 1696 (2009). In this case, the Veteran was notified of the respective duties of the claimant and of VA, as well as of the evidence needed to substantiate his claim for service connection for chronic lymphocytic leukemia by letters in April 2005 and June 2005 and for service connection for hepatitis C by letter in October 2005, before the adverse rating decisions that are the subject of this appeal. A March 2006 letter provided the Veteran with the specific notice required by Dingess, supra. A subsequent re- adjudication followed this notification. The Board thus concludes that VA has met its duty to notify the Veteran concerning his claim. The Board also concludes that VA has met its duty to assist the Veteran in developing the evidence to support his claim. The record contains his service treatment records and some service personnel records. The record also contains all available VA treatment records and private treatment records the Veteran authorized VA to obtain or submitted. Also of record is a March 2006 VA medical nexus opinion and the report of a VA examination of the Veteran in August 2007. The Board acknowledges the Veteran's general contentions that the March 2006 opinion and August 2007 examination were inadequate and biased. However, the Board has reviewed the findings from the examination reports and the March 2006 VA medical nexus opinion reflects that the examiner reviewed the Veteran's VA claims folder and rendered an appropriate opinion in conformity with the remainder of the evidence of record. The report of the August 2007 VA examination reflects that the examiner reviewed the Veteran's past medical history, recorded his current complaints, conducted an appropriate physical examination and rendered appropriate diagnoses and opinions consistent with the remainder of the evidence of record. The Board therefore concludes that the opinion and examination are adequate for rendering a decision in the instant case, and the Veteran's contentions as to inadequacy and bias are meritless. See 38 C.F.R. § 4.2 (2009); see also Barr v. Nicholson, 21 Vet. App. 303, 312 (2007). The Veteran testified before the undersigned. The Veteran has submitted magazine articles, medical treatise and medical study information. Statements and pictures from the Veteran's ex-wife, friends and fellow service members are of record. The Veteran has been accorded ample opportunity to present evidence and argument in support of the appeal. The Veteran has not indicated that there are any available additional pertinent records to support his claim. In sum, the Board is satisfied that the originating agency properly processed the Veteran's claim after providing the required notice and that any procedural errors in the development and consideration of the claim by the originating agency were insignificant and non-prejudicial to the Veteran. See Bernard v. Brown, 4 Vet. App. 384 (1993). II. Pertinent law and regulations Applicable law provides that service connection will be granted if it is shown that the Veteran suffers from disability resulting from an injury suffered or disease contracted in line of duty, or for aggravation of a preexisting injury suffered or disease contracted in line of duty, in active military service. 38 U.S.C.A. §§ 1110; 1131 (West 2002); 38 C.F.R. § 3.303 (2009). That an injury occurred in service alone is not enough; there must be chronic disability resulting from that injury. If there is no showing of a resulting chronic condition during service, then a showing of continuity of symptomatology after service is required to support a finding of chronicity. 38 C.F.R. § 3.303(b). For certain chronic disorders, including leukemia, service connection may be granted if the disease becomes manifest to a compensable degree within one year following separation from service. See 38 U.S.C.A. §§ 1101, 1112, 1113, 1137 (West 2002); 38 C.F.R. §§ 3.307, 3.309 (2009). Service connection may also be granted for any disease diagnosed after discharge, when all the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d). A Veteran who, during active military, naval, or air service, served in the Republic of Vietnam during the period beginning on January 9, 1962, and ending on May 7, 1975, shall be presumed to have been exposed during such service to an herbicide agent, unless there is affirmative evidence to establish that the Veteran was not exposed to any such agent during that service. The last date on which such a Veteran shall be presumed to have been exposed to an herbicide agent shall be the last date on which he or she served in the Republic of Vietnam during the period beginning on January 9, 1962, and ending on May 7, 1975. Service in the Republic of Vietnam includes service in the waters offshore and service in other locations if the conditions of service involved duty or visitation in the Republic of Vietnam. 38 U.S.C.A. § 1116(a)(3); 38 C.F.R. § 3.307(a)(6)(iii); see also 38 C.F.R. § 3.313(a). VA has stated that "service in the Republic of Vietnam" includes service on inland waterways. See 66 Fed. Reg. 23,166 (May 8, 2001). 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 U.S.C.A. § 1116; 38 C.F.R. § 3.307(a)(6)(iii) are met, even though there is no record of such disease during service, provided further that the rebuttable presumption provisions of 38 U.S.C.A. § 1113; 38 C.F.R. § 3.307(d) are also satisfied: chloracne or other acneform diseases consistent with chloracne, Type 2 diabetes mellitus, 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 C.F.R. § 3.309(e). Even if an appellant is found not entitled to a regulatory presumption of service connection, the claim must still be reviewed to determine if service connection can be established on a direct basis. See Combee v. Brown, 34 F.3d 1039 (Fed. Cir. 1994) (holding that the Veterans' Dioxin and Radiation Exposure Compensation Standards (Radiation Compensation) Act, Pub. L. No. 98-542, § 5, 98 Stat. 2724, 2727-29 (1984), does not preclude a Veteran from establishing service connection with proof of actual direct causation). III. History and Analysis Initial matter - claimed asbestos exposure The Veteran's presentation hinges, to some degree, on his contention that he was exposed to asbestos in service. In essence, he contends that his duties as a wheel vehicle mechanic caused him to come into contact with asbestos. See, e.g., the Veteran's March 2007 statement. There is no specific statutory guidance with regard to asbestos-related claims, nor has the Secretary of VA promulgated any regulations in regard to such claims. However, VA has issued a circular on asbestos-related diseases. DVB Circular 21-88-8, Asbestos-Related Diseases (May 11, 1988) provides guidelines for considering compensation claims based on exposure to asbestos. The information and instructions from the DVB Circular have been included in a VA Adjudication Procedure Manual, M21-1 (M21- 1), Part VI, 7.21. The Court has held that VA must analyze an appellant's claim to entitlement to service connection for asbestosis or asbestos-related disabilities under the administrative protocols under these guidelines. See Ennis v. Brown, 4 Vet. App, 523, 527 (1993); McGinty v. Brown, 4 Vet. App. 428, 432 (1993). VA Manual M21-1, Part VI, para. 7.21 (October 3, 1997) provides that inhalation of asbestos fibers can produce fibrosis and tumor, most commonly interstitial pulmonary fibrosis (asbestosis). Asbestos fibers may also produce pleural effusion and fibrosis, pleural plaques, mesotheliomas of pleura and peritoneum, lung cancer, and cancers of the gastrointestinal tract. Cancers of the larynx and pharynx, as well as the urogenital system (except the prostate) are also associated with asbestos exposure. Thus persons with asbestos exposure have increased incidence of bronchial, lung, pharyngolaryngeal, gastrointestinal and urogenital cancer. See M21-1, Part VI, para 7.21(a). The applicable section of Manual M21-1 also notes that some of the major occupations involving exposure to asbestos include mining, milling, work in shipyards, carpentry and construction, manufacture and servicing of friction products such as clutch facings and brake linings, manufacture and installation of roofing and flooring materials, asbestos cement and pipe products, military equipment, etc. High exposure to respirable asbestos and a high prevalence of disease have been noted in insulation and shipyard workers, and this is significant considering that, during World War II, U.S. Navy veterans were exposed to chrysotile, amosite, and crocidolite that were used extensively in military ship construction. Furthermore, it was revealed that many of these shipyard workers had only recently come to medical attention because the latent period for asbestos-related diseases varies from 10 to 45 or more years between first exposure and development of disease. Also of significance is that the exposure to asbestos may be brief (as little as a month or two) or indirect (bystander disease). See Department of Veterans Affairs, Veteran's Benefits Administration, Manual M21-1, Part 6, Chapter 7, Subchapter IV, § 7.21 b. In Dyment v. West, 13 Vet. App. 141, 145 (1999), the Court found that provisions in former paragraph 7.68 (predecessor to paragraph 7.21) of VBA Manual M21-1, Part VI, did not create a presumption of exposure to asbestos. Medical nexus evidence is required in claims for asbestos related disease related to alleged asbestos exposure in service. VA O.G.C. Prec. Op. No. 04-00. In short, with respect to claims involving asbestos exposure, VA must determine whether or not military records demonstrate evidence of asbestos exposure during service, develop whether or not there was pre-service and/or post-service occupational or other asbestos exposure, and determine whether there is a relationship between asbestos exposure and the claimed disease. See M21-1, Part VI, 7.21; DVB Circular 21- 88-8, Asbestos-Related Diseases (May 11, 1988). The Veteran's DD Form 214 confirms that his specialty in Army was a wheel vehicle mechanic. However, the Veteran has presented no evidence whatsoever that he was exposed to asbestos fibers thereby. His service medical records do not refer to any asbestos exposure, respiratory or pulmonary difficulties. Nor is there any post-service evidence which suggest in-service asbestos exposure. Indeed, the Veteran's claimed disabilities are not included in the list of disabilities associated with asbestos exposure in M21-1, Part VI, para 7.21(a). In short, the Veteran's contention that he was exposed to asbestos fibers while working as a wheel vehicle mechanic amounts to mere speculation of his part and is not substantiated by any objective evidence in the file. The Board accordingly finds that the Veteran was not exposed to asbestos in service. Chronic lymphocytic leukemia The Veteran contends that he was exposed to herbicides while in service and this later led to the development of chronic lymphocytic leukemia. The Veteran appears to assert that under the presumption provided by 38 C.F.R. § 3.309(e), he should be afforded presumptive service connection for his chronic lymphocytic leukemia, due to exposure to herbicides. The Board must take a liberal construction of his claim, that in lieu of presumptive service connection he is entitled to direct service connection for his chronic lymphocytic leukemia, including as due to herbicides and other environmental hazards. The Board notes that the Veteran has claimed this developed due to exposure to radiation at various points during the appellate period, but when the RO tried to continue to develop the claim as it related to radiation, the Veteran definitively stated in July 2007 that he did not wish to file a claim for service connection due to radiation exposure. The Board initially notes that the Veteran did not serve in Vietnam. Service personnel records reflect that his overseas duty was in Korea as a wheeled vehicle mechanic from January 1972 to February 1973 and as a motor sergeant from July 1978 to July 1979. The Veteran does not contend otherwise. The regulations related to presumptive herbicide exposure for Vietnam Veterans accordingly do not avail the Veteran. See 38 C.F.R. § 3.307(a)(6)(iii) (2009). For his part, the Veteran has contended that he was exposed to Agent Orange (herbicides) during his service in Korea. Review of the record, however, reveals that exposure to herbicides has not been objectively demonstrated. The Veteran essentially contends that he was involved in the spraying of Agent Orange near his base and was exposed to it through other spraying of areas near his base during his tours of duty in Korea. Specifically, he contends that he sprayed herbicides/defoliant in open sewer trenches at Camp Page Korea in 1972 to 1973 and witnessed the herbicides being sprayed to defoliate the motor pool area. The Veteran also contends that the vehicles he drove and worked on in Korea in 1978 to 1979 were equipped to spray herbicide/pesticide/fungicide mixtures. He had to maintain these trucks and was also constantly exposed to pesticides. The Veteran contends he was exposed to environmental hazards such as pesticides, benzene, heavy metals, solvents, brake fluid, diesel fuel/fumes, antifreeze, battery acid and triclorathane. The Veteran has submitted an April 2005 statement from his ex-wife indicating he was exposed to herbicides in Korea, as well as April 2007 statements from a fellow solider and pictures from his service in Korea in order to bolster his claim. The photos purportedly show how the troops were directed to dip their hands into 55-galon drums and drizzle the contents, "a goopy fluid," out of coffee cans to prevent air drift problems. This was used to prevent future weed growth. There is also a picture of battery acid being dumped into a barrel in the ground. The fellow soldier's statement contends that they were exposed to all manner of environmental hazards, as well as herbicides. During the Veteran's August 2009 hearing before the undersigned, he testified regarding many of his contentions already of record regarding his exposure to herbicides and pesticides. Crucially, while the United States Department of Defense has confirmed that herbicides, including Agent Orange, were used near the Korean demilitarized zone (DMZ) from April 1968 through July 1969, such use occurred a few years before the Veteran's induction into service, much less his deployment to Korea. The Defense Department has not indicated that Agent Orange or other herbicides were used in Korea during the time period of the Veteran's tours, and there is no objective evidence to the contrary. In addition, there is no evidence of record that shows any herbicides were employed in any other location during the time the Veteran served, including Hawaii. A March 2007 report from the National Personnel Records Center (NPRC) in response to a Personnel Information Exchange System (PIES) request indicated that there were no records of exposure to herbicides as it pertained to the Veteran. A request was made to the United States Army Center for Research of Unit Records (USACRUR) (now U.S. Army and Joint Services Records Research Center (JSRRC)) regarding this particular Veteran's potential exposure to herbicides. In April 2007 USASCRUR responded that Veteran's battalion was located at Camp Page, South Korea during April 1972 to September 1972, which is 6.2 miles from the DMZ. The unit the Veteran was in during June 1978 to July 1979 was located at Youngson Army Garrison, in Seoul, South Korea, which is located approximately 30 miles south of the DMZ. The report went on to discuss use of chemical herbicides along the southern boundary of the DMZ from 1967 to 1969 by the Republic of Korea Armed Forces. Records also stated that Agent Orange was used from April to August 1968. These findings do not support the Veteran's contentions of herbicide exposure in service. In fact, the only evidence in support of the Veteran's claim as to in-service herbicide exposure emanates from the Veteran himself, his ex-wife, and fellow soldier M.W. However, the Veteran has provided no objective evidence concerning his purported exposure to herbicides, and there is objective evidence to the contrary. The Veteran is certainly competent to testify that he sprayed chemicals and was exposed to spray. Layno v. Brown, 6 Vet. App. 465 (1994). Both the photos provided and the statements of a fellow soldier again speak to the fact that there were chemicals sprayed near the Veteran's base. However, there is no objective evidence showing this was Agent Orange or any of the other herbicides as covered by the regulation. In short, official records do not show that herbicide agents containing dioxin or 2, 4-dichlorophenxyacetic acid were used in Korea during the time period the Veteran served. On this basis, the Board concludes that the Veteran was not exposed to herbicides as described by the regulations during his period of active duty. The Board discounts as not probative the statements of the Veteran, his ex-wife and fellow soldier M.W. See Rucker v. Brown, 10 Vet. App. 67, 74 (1997) (stating that competency must be distinguished from weight and credibility, which are factual determinations going to the probative value of the evidence). However, although the Board does not find that the Veteran was exposed to herbicides, it does find that given the evidence of record, including his military occupational specialty and the photos and statements of his friend, the Veteran was exposed to various pesticides and other environmental hazards such as benzene, diesel fuel, solvents, brake fluid, etc. Having determined that the Veteran is not entitled to presumptive exposure to herbicides, obviating the need to engage in an analysis of presumptive service connection for chronic lymphocytic leukemia, the Board turns to evaluate whether the Veteran is entitled to service connection on a direct basis. See Combee, supra. Service treatment records are negative for any complaint, treatment, or diagnosis of chronic lymphocytic leukemia. With respect to in-service disease, there is no evidence of chronic lymphocytic leukemia in service or within the one- year presumptive period after service and the injury here alleged is exposure to herbicides and other environmental hazards. Post-service treatment records show the Veteran was diagnosed with chronic lymphocytic leukemia in March 2005. Subsequent records show the Veteran continues to suffer from this chronic condition. An April 2005 letter from Dr. J.B. opined that the likelihood that the Veteran was exposed to severe noxious agents is extremely high. He indicated that Agent Orange's toxic life in the soil is poorly understood, but it is thought to approach 100 years. So the possibility of exposure even to that agent was very high. Dr. J.B. indicated that he told the Veteran it would be very difficult for him to prove with certainty that the exposure exists though he suspected that exposure was very likely in the Veteran's case. An August 2007 VA examiner, who reviewed the Veteran's entire claims file, noted the Veteran reported he was stationed in Korea as a mechanic and used and was exposed to herbicides. He claimed he was also exposed to benzene as a mechanic and exposed to battery acid and fumes. The examiner noted that the Veteran was not receiving treatment for chronic lymphocytic leukemia. The examiner also noted the Veteran claimed that a 1976 CBC test report showed he had indications of chronic lymphocytic leukemia. This April 1976 CBC report of 5500 WBCs with immature marked negative. Differential with 57 neutrophils, 38 lymphocytes and 4 eosinophils and 24 platelets. Hemoglobin was 17.4, hematocrit was 51. An annotation showed slight macrocytosis. The examiner then discussed in detail a number of research studies, including studies the Veteran submitted. After describing some specific studies, the examiner noted that a review of over 375 journals and other resources report that there are no clearly discernible occupational or environmental risk factors that predispose chronic lymphocytic leukemia, including chronic antigenic stimulation. The examiner opined that the Veteran's chronic lymphocytic leukemia was less likely than not the result of environmental exposures during active duty service. Research that has been conducted has not shown a significant association between any environmental or occupational risk factor. In addition, the Veteran reported exposures to numerous chemicals and environmental risk, but no specific amounts or duration of exposures or verification of the exposures can be assumed. The examiner also opined it was less likely than not that the chronic lymphocytic leukemia had its initial onset during active duty service. The examiner explained that the diagnostic criteria of chronic lymphocytic leukemia does not include elevated hemoglobin or hematocrit or macrocytosis. Diagnostic criteria are based on lymphocytosis sustained over time. The Veteran's CBCs indicate lymphocytosis sustained over time since May of 2003 but this is not evidence with BCB in April 1976, which is 27 years prior to May 2003. The Veteran does not appear to contend that he developed chronic lymphocytic leukemia during service or that it manifested to a compensable level within the first year after service; and the evidence does not show this. The Court has indicated that the absence of any medical records of a diagnosis or treatment for many years after service is probative evidence against the claim. See Mense v. Derwinski, 1 Vet. App. 354, 356 (1991) (affirming Board where it found that Veteran failed to account for the lengthy time period after service for which there was no clinical documentation of low back condition); see also Maxson v. Gober, 230 F.3d 1330, 1333 (Fed. Cir. 2000) (a prolonged period without medical complaint can be considered, along with other factors concerning a claimant's health and medical treatment during and after military service, as evidence of whether an injury or a disease was incurred in service which resulted in any chronic or persistent disability). There are no active duty service treatment records documenting any complaints or treatment in service regarding chronic lymphocytic leukemia. Additionally, there are no medical records indicating complaints or treatment for chronic lymphocytic leukemia within the first year after discharge from active duty service. The earliest post- service diagnosis of chronic lymphocytic leukemia is in 2005 medical records. This is twenty-six years after discharge from active service. The length of time between the Veteran's discharge from service and his diagnosis of chronic lymphocytic leukemia is probative evidence against the appellant's claim. The only competent medical opinion of record concerning the issue of medical nexus is an August 2007 VA opinion. Specifically, the VA examiner opined that the Veteran's current chronic lymphocytic leukemia did not have its initial onset in service and was not related to any environmental exposures during active duty service. This VA medical opinion appears to have been based on a thorough review of the record, including the Veteran's comprehensive treatment records, and a thoughtful analysis of the Veteran's entire history. See Bloom v. West, 12 Vet. App. 185, 187 (1999) (the probative value of a physician's statement is dependent, in part, upon the extent to which it reflects 'clinical data or other rationale to support his opinion.'). Additionally, the August 2007 opinion appears to be consistent with the Veteran's entire medical history. There is no competent medical opinion to the contrary. Neither the Veteran nor his previous representative has produced a medical opinion to contradict the August 2007 VA medical opinion. As is explained in the VCAA section below, the Veteran has been accorded ample opportunity to present competent medical nexus evidence in support of his claim. He has failed to do so. See 38 U.S.C.A. § 5107(a) (West 2002) (it is the claimant's responsibility to support a claim for VA benefits). Throughout the claims process the Veteran has submitted a voluminous number of articles, studies and treatises containing information about major events in learning about Agent Orange, locations where it was used and various impacts upon health, including studies involving leukemia. The fact that the these studies indicate the relationship between herbicides or environmental hazards and various symptoms and conditions does not provide a medical nexus between this Veteran's service and his chronic lymphocytic leukemia, however. See Libertine v. Brown, 9 Vet. App. 521, 522-523 (1996). Thus, while the Veteran has stated the belief that his chronic lymphocytic leukemia was caused by his exposure to herbicides and environmental hazards or is otherwise related to his military service, as a layperson he is generally not qualified to furnish medical opinions or diagnoses. Espiritu v. Derwinski, 2 Vet. App. 492, 494-495 (1992); see also 38 C.F.R. § 3.159(a) (1) (2009) (competent medical evidence means evidence provided by a person who is qualified through education, training, or experience to offer medical diagnoses, statements, or opinions). In summary, there is no indication of exposure to herbicides in service, of an injury suffered in service related to chronic lymphocytic leukemia or diagnosis of the condition in service, no continuity of symptomatology directly related to chronic lymphocytic leukemia since discharge from service and no medical nexus opinion between the Veteran's chronic lymphocytic leukemia and any aspect of his military service, to include as secondary to herbicides and environmental hazards, such as pesticides. For the Board to conclude that the Veteran's chronic lymphocytic leukemia is related to the Veteran's military service in these circumstances would be speculation, and the law provides that service connection may not be based on resort to speculation or remote possibility. 38 C.F.R. § 3.102; Obert v. Brown, 5 Vet. App. 30, 33 (1992). Therefore, the evidence of record does not support the claim for service connection for chronic lymphocytic leukemia, including as due to exposure to herbicides and environmental hazards. Since the most probative evidence and the greater weight of the evidence indicate that the Veteran's chronic lymphocytic leukemia was not as a result of his military service, to include as due to exposure to herbicides and environmental hazards, the preponderance of the evidence is against the claim. As the preponderance of the evidence is against the claim, the benefit of the doubt doctrine is not applicable, and the claim for service connection for chronic lymphocytic leukemia must be denied. Gilbert v. Derwinski, 1 Vet. App. 49 (1990). Hepatitis C The medical evidence of record demonstrates a diagnosis of hepatitis C in March 2005. A continuing hepatitis C diagnosis has been documented in more recent VA treatment records. Regarding in-service disease or injury, service treatment records are negative for any diagnosis or indication of hepatitis. [The Board observes that hepatitis C was not diagnosed, nor could it have been, since hepatitis C was not specifically denominated as such until the 1980's]. The Veteran has put forth a number of different theories of contracting hepatitis C, including that in service while hospitalized his IV catheter disconnected, causing the Veteran to be covered with blood in his bed. He also related it to contracting urethritis while in service and being subject to all sorts of environmental hazards, including contaminated water, pesticides, feces, bugs, etc. while stationed in Korea. The Veteran has also asserted he may have contracted it from immunizations he received in service. A June 1984 VA pension psychiatric examination noted that the Veteran had suffered some bruises in an altercation with police. During that examination he admitted that at one time he drank heavily, but now only drank socially. The Veteran described using pot whenever he could afford it, about once a month or so. He stated that in the Army he became disgusted and disgruntled and started drinking a good deal. In addition, while denying the use of drugs such as heroin or morphine, he did admit that he once experimented with speed. A September 1995 memorandum shows the Veteran was discharged by the Pennsylvania National Guard for the reason of Misconduct - Abuse of Illegal Drugs. A March 2006 claims file review examiner noted the Veteran's contentions. She also noted that the Veteran was a wheeled vehicle mechanic and not in combat. Exposure to blood products was highly unlikely. An examination report from 1984 noted that the Veteran related a prior history of excessive alcohol use. The examiner stated that although the Veteran denied drug use, he was discharged from the National Guard in 1995 for misconduct, abuse of illegal drugs. The examiner looked at the Veteran's hospitalization during service for gastroenteritis, but noted he was not given any blood transfusions. The IV catheter did indeed become disconnected, but the blood he was covered with was his own. He did not require transfusion after the event because he did not have significant blood loss. No records regarding a nonspecific urethritis in the military were located. The examiner noted the Veteran's reported alcohol and drug used as relayed in 1984, as well as some issues with law enforcement related to intoxication. The examiner noted National Guard medical examinations in 1991 and 1995 and that no indications of hepatitis C or symptoms related to it were found. The examiner opined against the Veteran's theories as they related to the blood from the catheter, urethritis or exposure to environmental hazards, including contaminated water, pesticides, feces, bugs, etc. while stationed in Korea, reasoning that the Veteran was in a low-risk occupation while in Korea and was therefore not exposed to blood-borne organisms that could have exposed him to hepatitis C. She opined that the most likely etiology for the Veteran's development of hepatitis C would be related to high-risk personal behaviors. An August 2007 examiner, who reviewed the Veteran's entire claims file and examined the Veteran, noted that the Veteran reported he believed he received a blood transfusion in 1970 when he was hooked up to an IV and it came undone. He reported being in a couple of fights in 1971and 1976 in service and blood was splashed on him. There was an indication of nonspecific urethritis in service and an antibiotic injection. The Veteran denied past or present intravenous drug use. The examiner referred to the Veteran's October 2005 hepatitis risk exposure questionnaire, noting high-risk sexual activity from 1972 to 1973 and from 1978 to 1970. He also indicated shared razor blades in service. The examiner then went through the research related to hepatitis C contraction. The examiner opined that it was less likely than not that hepatitis C infection was the result of some factor circumstances associated with active duty service. The examiner indicated that there was no research or evidence that hepatitis C can be transmitted though chemicals or environmental hazards and there is no evidence that the Veteran received a blood transfusion after accidental IV disconnection. The Veteran was in a low risk occupation in Korea, so he was not exposed to blood-borne organisms that would have exposed him to hepatitis C. Research indicated a .1 percent chance of transmission from exposure of blood or body fluids to mucous membranes. The examiner opined that the most likely etiology for the Veteran's development of hepatitis C would be related to high-risk personal behaviors. During the Veteran's August 2009 hearing before the undersigned, he testified regarding many of his contentions already of record related to hepatitis C. He testified that he thought he had received a blood transfusion in service, but was not sure. The Veteran claims he never had any symptoms and was diagnosed in 2005. The only competent medical opinions of record concerning the issue of medical nexus are the March 2006 and August 2007 VA opinions. Specifically, the VA examiners opined that the Veteran's currently diagnosed hepatitis C is not related to the Veteran's military service. With respect to the current diagnosis of hepatitis C, the VA examiners concluded that the Veteran's hepatitis C is most likely related to high-risk personal behaviors. While the examiners did not specifically address the issue of contamination due to immunizations in their rationale, they methodically went through the research related to hepatitis C contraction, had access to all of the Veteran's records in the claims file and provided a likely etiology of the disability. These VA medical opinions appear to have been based on a thorough review of the record, including the Veteran's comprehensive treatment records, and a thoughtful analysis of the Veteran's entire history. See Bloom, supra. Additionally, the March 2006 and August 2007 opinions appear to be consistent with the Veteran's entire medical history, which does not show ongoing problems with hepatitis after service and which demonstrates that he was not diagnosed with hepatitis C until March 2005. Moreover, the evidence demonstrates that the Veteran has some degree of high-risk factors for hepatitis, including indications of alcohol and drug abuse, high risk sexual activity, shared razor blades and receiving a tattoo. The various evidence of record supports a finding of these risk factors. Accordingly, the VA examiners' conclusion that the Veteran's currently diagnosed hepatitis C is most likely due to high-risk personal behaviors is supported by the evidence. There is no competent medical opinion to the contrary. Neither the Veteran nor his previous representative has produced a medical opinion to contradict the March 2006 and August 2007 VA medical opinions. As is explained in the VCAA section below, the Veteran has been accorded ample opportunity to present competent medical nexus evidence in support of his claim. He has failed to do so. See 38 U.S.C.A. § 5107(a), supra. To the extent that the Veteran has claimed that the currently diagnosed hepatitis C is related to any aspect of his military service, including as due to transfusions or immunizations or other exposures, it is now well-established that laypersons without medical training, such as the Veteran and his representative, are usually not competent to comment on medical matters such as etiology. See Espiritu and 38 C.F.R. § 3.159(a), both supra. To some extent, the Veteran appears to be contending that he has suffered from hepatitis C continually since service. The Board is aware of the provisions of 38 C.F.R. § 3.303(b), discussed above, relating to chronicity and continuity of symptomatology. However, supporting medical evidence is required. See Voerth v. West, 13 Vet. App. 117, 120-121 (1999) (there must be medical evidence on file demonstrating a relationship between the Veteran's current disability and the claimed continuous symptomatology, unless such a relationship is one as to which a lay person's observation is competent). Such evidence is lacking in this case. Specifically, as was indicated above, the earliest hepatitis C diagnosis of record was in March 2005. Therefore, there is no competent medical evidence that the Veteran had hepatitis C for twenty-six years after his December 1979 discharge from active military service. Rather, as discussed above, the March 2005 hepatitis C diagnosis followed a long period of time since discharge from service and the Board notes the finding of significant risk factors. Continuity of symptomatology after service is therefore not demonstrated by the record. The Board notes that, as indicated above, the Veteran's history of post-service drug and alcohol use is documented in a June 1984 VA treatment report. The Veteran does not appear to contend that his current hepatitis C is a result of in- service drug abuse. Even if such were the case, drug abuse is considered by law to be misconduct, and as a matter of law service connection may not be granted for any disease resulting therefrom. See 38 U.S.C.A. § 1110 (West 2002); 38 C.F.R. §§ 3.1(n), 3.301 (2009); see also VAOPGCREC 7-99 (1999); VA-OPGCREC 2-98 (1998). As the preponderance of the evidence is against the claim, the benefit of the doubt doctrine is not applicable, and the claim for service connection for hepatitis C must be denied. Gilbert v. Derwinski, 1 Vet. App. 49 (1990). ORDER Service connection for chronic lymphocytic leukemia is denied. Service connection for hepatitis C is denied. ____________________________________________ S. BUSH Acting Veterans Law Judge, Board of Veterans' Appeals Department of Veterans Affairs