Citation Nr: 1237698 Decision Date: 11/02/12 Archive Date: 11/09/12 DOCKET NO. 08-30 107 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in Manila, the Republic of the Philippines THE ISSUE Entitlement to service connection for the cause of the Veteran's death. REPRESENTATION Appellant represented by: Disabled American Veterans ATTORNEY FOR THE BOARD E. Pomeranz, Counsel INTRODUCTION Service personnel records show that the Veteran served in the Philippine Commonwealth Army from November 24, 1941 to January 11, 1943, and from February 13, 1946 to March 14, 1946. He was a prisoner of war (POW) from May 10, 1942 to January 11, 1943. The Veteran died in April 1973. The appellant is the widow of the Veteran. This matter comes before the Board of Veterans' Appeals (Board) on appeal of a February 2008 rating action by the Department of Veterans Affairs (VA) Regional Office (RO) located in Manila, the Republic of the Philippines. In a March 2010 decision, the Board reopened the claim for service connection for the cause of the Veteran's death and remanded the underlying service connection claim for additional development. The purposes of this remand have been met and the case is ready for appellate consideration. Although the appellant had initially requested in her substantive appeal a hearing at the Central Office in Washington, D.C., she subsequently withdrew that request in September 2011. See 38 C.F.R. § 20.702(e) (2012). Please note this appeal has been advanced on the Board's docket pursuant to 38 C.F.R. § 20.900(c) (2012). 38 U.S.C.A. § 7107(a)(2) (West 2002). FINDINGS OF FACT 1. The Veteran's death certificate was executed by Dr. D.M.V. in January 2004; Dr. V. stated that the Veteran died in April 1973 and that the cause of his death was cardiopulmonary arrest secondary to chronic illnesses, pulmonary tuberculosis (PTB); Dr. V. never treated the Veteran. 2. At the time of the Veteran's death, service connection was not in effect for any disease or disability. 3. PTB did not have its onset during active service; PTB did not manifest within three years of separation from active service; and PTB is not shown to be otherwise related to the Veteran's active service. 4. There is no competent evidence of a nexus between the cause of the Veteran's death and his active service. CONCLUSION OF LAW Service connection for the cause of the Veteran's death is not warranted. 38 U.S.C.A. §§ 1101, 1110, 1112, 1113, 1310, 5107 (West 2002 & Supp. 2011); 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309, 3.312 (2012). REASONS AND BASES FOR FINDINGS AND CONCLUSION I. Veterans Claims Assistance Act of 2000 (VCAA) The VCAA enhanced VA's duty to notify a claimant as to the information and evidence necessary to substantiate a claim for VA benefits. 38 U.S.C.A. §§ 5100, 5102, 5103, 5103A, 5107, 5126 (West 2002 & Supp. 2011); 38 C.F.R. §§ 3.102, 3.156(a), 3.159, 3.326(a) (2012). The VCAA also redefined the obligations of VA with respect to the duty to assist the appellant with the claim. Id. In the instant case, the Board finds that VA fulfilled its duties to the appellant under the VCAA. Duty to Notify VA has a duty to notify the appellant of any information and evidence needed to substantiate and complete a claim. 38 U.S.C.A. §§ 5102, 5103. The Board concludes that the letters dated in December 2007, May 2010, and July 2010 that were sent to the appellant adequately apprised her of the information and evidence needed to substantiate the claim. The RO thus complied with VCAA's notification requirements. In order to meet the requirements of 38 U.S.C. § 5103(a) and 38 C.F.R. § 3.159(b), VCAA notice must: (1) inform the claimant about the information and evidence necessary to substantiate the claim; (2) inform the claimant about the information and evidence that VA will seek to provide; and (3) inform the claimant about the information and evidence the claimant is expected to provide. Beverly v. Nicholson, 19 Vet. App. 394, 403 (2005) (outlining VCAA notice requirements). The Court of Appeals for Veterans' Claims (Court) determined in Hupp v. Nicholson, 21 Vet. App. 342 (2007) that, when adjudicating a claim for dependency and indemnity compensation (DIC), VA must perform a different analysis depending upon whether a veteran was service connected for a disability during his or her lifetime. The Court concluded that, in general, section 5103(a) notice for a DIC case must include (1) a statement of the conditions, if any, for which a veteran was service- connected at the time of his or her death; (2) an explanation of the evidence and information required to substantiate a claim for service connection for the cause of the Veteran's death based on a previously service-connected condition; and (3) an explanation of the evidence and information required to substantiate a claim based on a condition not yet service connected. Additionally, on March 3, 2006, the Court issued a decision in Dingess v. Nicholson, 19 Vet. App. 473, 484, 486 (2006), which held that the VCAA notice requirements of 38 U.S.C.A. § 5103(a) and 38 C.F.R. § 3.159(b) apply to all five elements of a service connection claim. Those five elements 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. The Board finds that VA has met these duties with regard to the claim adjudicated on the merits in this decision. There is no issue as to providing an appropriate application form or completeness of the application. Written notice provided in December 2007, May 2010, and July 2010 fulfills the provisions of 38 U.S.C.A. § 5103(a). That is, the appellant received notice of the evidence needed to substantiate her claim, the avenues by which she might obtain such evidence, and the allocation of responsibilities between herself and VA in obtaining such evidence. See Beverly, 19 Vet. App. at 394, 403; see also Mayfield v. Nicholson, 19 Vet. App. 103, 109-12 (2005) (Mayfield I) rev'd on other grounds, 444 F.3d 1328 (Fed. Cir. 2006). In addition, the May 2010 letter informed the appellant about how VA determines effective dates and disability ratings, as required by Dingess. Regarding the Hupp requirements, the first two of the three elements are not applicable as service connection was not in effect for any disease or disability during the Veteran's lifetime. With respect to the third element, as noted above, the appellant received notice of the evidence needed to substantiate her claim. Thus, the third and final element of Hupp is satisfied. The Board also recognizes that, according to Pelegrini v. Principi, 18 Vet. App. 112, 119-20 (2004), proper VCAA notice must "precede an initial unfavorable [agency of original jurisdiction (AOJ)] decision on a service-connection claim." Written notice was provided in December 2007, prior to the appealed from rating decision, along with the subsequent notice provided in May and July 2010, after the decision that is the subject of this appeal. With respect to any timing deficiency, the Board notes that the case was subsequently readjudicated in March 2009 and May 2012 supplemental statements of the case (SSOCs) and, as such, the appellant has not been prejudiced thereby. See Bernard v. Brown, 4 Vet. App. 384, 394 (1993) (where the Board addresses a question that has not been addressed by the agency of original jurisdiction, the Board must consider whether the Veteran has been prejudiced thereby). The appellant has been provided the opportunity to respond to VA correspondence and over the course of the appeal and has had multiple opportunities to submit and identify evidence. Furthermore, she has been provided a meaningful opportunity to participate effectively in the processing of her claim by VA. Duty to Assist VA also has a duty to assist the veteran in obtaining evidence necessary to substantiate the claim. 38 U.S.C.A. § 5103A(a) ("The Secretary shall make reasonable efforts to assist a claimant in obtaining evidence necessary to substantiate the . . . claim"). This duty includes assisting the claimant in obtaining records and providing medical examinations or obtaining medical opinions when such are necessary to make a decision on the claim. 38 U.S.C.A. § 5103A(b), (c), (d) (setting forth Secretary's various duties to claimant). VA informed the appellant of its duty to assist in obtaining records and supportive evidence. In this regard, the Board remanded this appeal in May 2010, primarily for the purpose of contacting a Dr. C. to obtain any records relating to treatment of the Veteran, including records cited in Dr. C.'s March 2004 statement, and any records from 1960 to the Veteran's death in April 1973. In July 2010, the RO sent a letter to Dr. C. requesting the aforementioned records. In a return response, dated in September 2010, Dr. C. stated that he had summarized the Veteran's medical records based on an old "OPD card," which he had personally reviewed and which had been furnished by Dr. P.D. of the Diaz General Clinic. According to Dr. C., the OPD card was lost and could not be found. Dr. C. noted that only a Xerox copy of the evidence was available. He attached a copy of the handwritten treatment notes purportedly from the Diaz General Clinic that had been previously submitted in August 2004. He also submitted a copy of his private medical statement which he had submitted in March 2004 in which he discussed the Veteran's medical history. There is no indication in the record that any additional evidence relevant to the appellant's cause of death claim is available and not part of the claims file. 38 U.S.C.A. § 5103A; 38 C.F.R. § 3.159. As explained in more detail below, there is no credible evidence of record which indicates that the Veteran's fatal PTB was related to his period of service. Under these circumstances, VA is not required to obtain an opinion regarding whether the Veteran's death was attributable to service. See 38 C.F.R. § 3.159 (c)(4). Based on the foregoing, it is the Board's determination that the VA fulfilled its VCAA duties to notify and to assist the appellant, and thus, no additional assistance or notification was required. The appellant has suffered no prejudice that would warrant a remand, and her procedural rights have not been abridged. See Bernard, supra. II. Pertinent Laws and Regulations In general, service connection may be granted for an injury or disease incurred in or aggravated by military service. 38 U.S.C.A. § 1110 (West 2002). 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) (2012). Service connection for PTB may be established on a presumptive basis if such is manifested to a compensable degree within three years following a veteran's separation from active duty. 38 U.S.C.A. §§ 1101, 1112(a), 1113; 38 C.F.R. §§ 3.307, 3.309(a). A diagnosis of active PTB by private physicians on the basis of their examination, observation, or treatment will not be accepted to show the disease was initially manifested [at a specific point in time] after discharge from active service unless it is confirmed by acceptable clinical, X-ray or laboratory studies, or by findings of active tuberculosis based upon acceptable hospital observation or treatment. 38 C.F.R. § 3.374(c); Tubianosa v. Derwinski, 3 Vet. App. 181 (1992). Section 3.309(c) provides that if a veteran is a former POW, certain, enumerated diseases "shall be service connected if manifest to a degree of disability of 10 percent or more at any time after discharge or release from active . . . service even though there is no record of such disease during service . . . ." 38 C.F.R. § 3.309(c); accord 38 U.S.C.A. § 1112(b). The qualifying diseases are: psychosis; any of the anxiety states; dysthymic disorder (or depressive neurosis); organic residuals of frostbite; post-traumatic osteoarthritis; atherosclerotic heart disease or hypertensive vascular disease (including hypertensive heart disease) and their complications (including myocardial infarction, congestive heart failure, arrhythmia); stroke and its complications; avitaminosis; beriberi (including beriberi heart disease); chronic dysentery; helminthiasis; malnutrition (including optic atrophy associated with malnutrition); pellagra; any other nutritional deficiency; irritable bowel syndrome; peptic ulcer disease; peripheral neuropathy except where directly related to infectious causes; and cirrhosis of the liver. 38 C.F.R. § 3.309(c); accord 38 U.S.C.A. § 1112(b). To establish service connection for the cause of the veteran's death, evidence must be presented which in some fashion links the fatal disease to a period of active service or an already service-connected disability. See 38 U.S.C.A. §§ 1110, 1310; 38 C.F.R. §§ 3.303, 3.310, 3.312. In short, the evidence must show that a service-connected disability was either the principal cause or a contributory cause of death. For a service-connected disability to be the principal (primary) cause of death it must singly or with some other condition be the immediate or underlying cause or be etiologically related. For a service-connected disability to constitute a contributory cause it must contribute substantially or materially; it is not sufficient to show that it casually shared in producing death, but rather it must be shown that there was a causal connection. 38 U.S.C.A. § 1310; 38 C.F.R. § 3.312; see also Gabrielson v. Brown, 7 Vet. App. 36, 39 (1994). Lay evidence can be competent and sufficient to establish a diagnosis of a condition when (1) a layperson is competent to identify the medical condition, (2) the layperson is reporting a contemporaneous medical diagnosis, or (3) lay testimony describing symptoms at the time supports a later diagnosis by a medical professional. Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007). Lay persons can also provide an eye-witness account of an individual's visible symptoms. See Davidson v. Shinseki, 581 F.3d 1313 (2009)(noting that a layperson may comment on lay-observable symptoms). Competency of evidence differs from weight and credibility. The former is a legal concept determining whether testimony may be heard and considered by the trier of fact, while the latter is a factual determination going to the probative value of the evidence to be made after the evidence has been admitted. Rucker v. Brown, 10 Vet. App. 67, 74 (1997); Layno v. Brown, 6 Vet. App. 465, 469 (1994); see also Cartright v. Derwinski, 2 Vet. App. 24, 25 (1991) ("although interest may affect the credibility of testimony, it does not affect competency to testify"). In rendering a decision on appeal, the Board must analyze the credibility and probative value of the evidence, account for the evidence which it finds to be persuasive or unpersuasive, and provide the reasons for its rejection of any material evidence favorable to the claimant. See Gabrielson v. Brown, 7 Vet. App. 36, 39-40 (1994); Gilbert v. Derwinski, 1 Vet. App. 49, 57 (1990). III. Factual Background The Veteran's service treatment records are sparse and consist of an Affidavit for Philippine Army Personnel, dated in March 1946, and the Veteran's separation examination report, dated in February 1946. In the Affidavit, the Veteran swore that he had incurred no wounds or illnesses during the period from December 1941 to the present date. In the February 1946 separation examination report, the Veteran's cardiovascular system and lungs, including x-ray, were reported to be negative. In a Certificate of Death, it was noted that the Veteran died in April 1973. The cause of the Veteran's death was listed as cardiopulmonary arrest secondary to chronic illnesses, PTB. The Certificate of Death was signed by Dr. D.M.V. in January 2004. In April 2004, the appellant filed her initial claim for service connection for the cause of the Veteran's death. In a private medical statement from Dr. C.C.C., of the Diaz Clinic, dated in March 2004, Dr. C. stated that a review of a medical record that was pertinent to the Veteran and was kept in the "record section from the time of treatment," showed that the Veteran was first treated in February 1947 for complaints of chest pain, cough and dyspnea, and epigastric pain and discomfort. The diagnosis was costochondritis. In June 1949, the Veteran was again treated for complaints of cough, with dyspnea and loss of appetite. He was diagnosed with pneumonitis and costochondritis. The Veteran had pain and tenderness at the right anterior chest area with probable fracture of ribs. In May 1952, a repeat consultation was conducted in response to the Veteran's complaints of chest and back pain with cough for one month. The diagnoses were pneumonitis, arthritis, and costochondritis. In June 1956, the Veteran was treated for complaints of cough with blood streak sputum (phlegm), with loss of appetite and loss of weight. The diagnoses were pneumonia/PTB and peptic ulcer disease. In September 1960, the Veteran was treated for complaints of chronic cough and weight loss. He was diagnosed with pneumonitis and costochondritis. In a letter from the RO to the Diaz Clinic, dated in June 2004, the RO requested pertinent treatment records relating to the Veteran. In a return response, the RO was notified that the Diaz Clinic was closed. In August 2004, the RO received a copy of handwritten treatment notes purportedly from the Diaz General Clinic. According to the notes, in February 1947, the Veteran was treated for complaints of chest pain and dyspnea. The diagnosis was costochondritis. In June 1949, the Veteran was treated for complaints of a cough, dyspnea, and loss of appetite. The diagnoses were pneumonitis and costochondritis. The Veteran was again diagnosed with pneumonitis in 1952. In June 1956, he was treated for coughing of blood and loss of appetite. The diagnosis was "PTB?" In September 1960, the diagnosis of PTB was again considered. In an Affidavit from Dr. D.M.V., signed in August 2004, Dr. V. stated that from June 2003 to May 2004, he was connected with the local government unit of Sulop as a Municipal Health Officer. Dr. V. indicated that his duties included signing death certificates. According to Dr. V., he was approached by the Veteran's daughter to sign the Veteran's Death Certificate. Dr. V. noted that he asked the Veteran's daughter what the cause of his death was and she answered that prior to the Veteran's death, he was vomiting blood and was suffering from tuberculosis. Dr. V. stated that he based the approval of the Veteran's death certificate on the information provided by the Veteran's daughter. In a statement from the appellant, received in August 2004, she reported that in 1965, the Veteran was hospitalized at the Zantura Hospital and was diagnosed with an ulcer and tuberculosis. According to the appellant, the Veteran was again hospitalized in 1969 and 1970 for his ulcer. She indicated that she had tried to get pertinent records from the Zantura Hospital but that she was informed that the related records had been burned. In a Joint Affidavit, dated in February 2006, Ms. A.M. and Ms. F.A., attested that they were neighbors of the Veteran and that when he returned home in 1949, he was sickly and suffering from illnesses due to his experiences in the war. In an Affidavit, dated in August 2007, Mr. T.L. attested that he had been in the same POW camp with the Veteran. According to Mr. L., they experienced several illnesses while they were in the prison camp. Mr. L. indicated that the Veteran had received treatment at the Diaz Clinic for pneumonia, PTB, and peptic ulcer disease. In a private medical statement from Dr. C.C.C., dated in August 2007, Dr. C. stated that "by the reasonable doubt doctrine, the sickness of the Veteran was aggravated by strenuous physical and psychological conditions" both during and after the war. Dr. C. indicated that when the Veteran was treated at the Diaz Clinic, there was no laboratory facility available. However, Dr. C. reported that even without any laboratory testing, the Veteran was probably suffering from multiple illnesses, including peptic ulcer disease, PTB, and arthritis. According to Dr. C., the Veteran's Death Certificate was prepared almost 30 years after his death and the person who furnished the data was not reliable; hence, the cause of death was listed as cardiopulmonary arrest, probable PTB. Dr. C. stated that at the time of the Veteran's death, the Veteran was also suffering from chronic peptic ulcer disease. According to Dr. C., bleeding peptic ulcer disease was "maybe" the condition that was responsible for the Veteran's death and should have been included in the Death Certificate. Dr. C. indicated that if bleeding peptic ulcer disease was not the principal cause of the Veteran's death, it may be considered a contributory cause of death. In a letter from the Veteran's son, dated in October 2008, the Veteran's son stated that in 1970, a doctor told the Veteran that he had peptic ulcer and tuberculosis. In April 1973, the Veteran died and his physician reported that the cause of his death was peptic ulcer and PTB. The Veteran's son attached a copy of a Certificate of Death for the Veteran. However, no cause of death was listed. Pursuant to the Board's March 2010 remand, the RO sent a letter to Dr. C.C.C. in July 2010 and requested that he provide medical records pertinent to the Veteran's treatment from 1960 to April 1973. In a return response, dated in September 2010, Dr. C. stated that he had summarized the Veteran's medical records based on an old "OPD card," which he had personally reviewed and which had been furnished by Dr. P.D. of the Diaz General Clinic. According to Dr. C., the OPD card was lost and could not be found. Dr. C. noted that only a Xerox copy of the evidence was available. He attached a copy of the handwritten treatment notes purportedly from the Diaz General Clinic that had been previously submitted in August 2004. He also submitted a copy of his private medical statement which he had submitted in March 2004 in which he discussed the Veteran's medical history. IV. Analysis With respect to the probative value of the two death certificates of record, the Board notes that in October 2008, the Veteran's son submitted a letter with an attached copy of a Certificate of Death for the Veteran. The Veteran's son stated that after the Veteran died in April 1973, his physician reported that the cause of the Veteran's death was peptic ulcer and PTB. However, upon a review of the attached Certificate of Death, the Board notes that no cause of death was listed. Thus, such Certificate of Death has no probative value. Nevertheless, as explained further below, the Board will accept that one of the causes of the Veteran's death is PTB. However, also as explained further below, there is no credible evidence of record showing that the Veteran died of peptic ulcer disease. Therefore, given that the Veteran's son did not provide any supporting clinical data to show that the Veteran died of peptic ulcer disease, the Board finds that the statements from the Veteran's son are not credible. In regard to the probative value of the death certificate signed by Dr. D.M.V. in January 2004, the Board finds that such death certificate does not hold substantial probative weight. In this regard, in an August 2004 affidavit, Dr. V. stated that while he was working as a Municipal Health Officer from June 2003 to May 2004, he was contacted by the Veteran's daughter to sign the Veteran's death certificate. According to Dr. V., he based the approval of the Veteran's death certificate on the information provided to him by the Veteran's daughter. Thus, he never treated the Veteran and when he indicated on the Death Certificate that the cause of the Veteran's death was cardiopulmonary arrest secondary to chronic illnesses, PTB, such determination was solely based on the information provided to him by the Veteran's daughter and not on any medical records. The Veteran's daughter had told Dr. V. that prior to the Veteran's death, he was vomiting blood and was suffering from tuberculosis. However, it does not appear that she provided any medical records regarding the Veteran's treatment and diagnoses immediately leading to his death, including any clinical, X-ray or laboratory studies confirming a diagnosis of PTB. See 38 C.F.R. § 3.374. Thus, the credibility of the findings of the death certificate signed by Dr. V. is questionable. Regardless, even if the Board accepts the Death Certificate signed by Dr. V. as a credible document, the Board finds that the preponderance of the evidence is against the appellant's claim for service connection for the cause of the Veteran's death. Although the Board will accept that PTB was one of the causes of the Veteran's death, the Board notes that there is no acceptable clinical, X-ray, or laboratory studies of record which actually confirm a diagnosis of PTB at any point in the Veteran's lifetime. In this regard, the Veteran's February 1946 separation examination report is negative for any complaints or findings of cardiopulmonary arrest or PTB. In fact, at the time of the Veteran's separation examination, his cardiovascular system and lungs, including x-ray, were reported to be negative. The Board recognizes the appellant's contention that the Veteran's PTB was incurred in service as a result of his POW experiences. The Board also recognizes the appellant's contention that the Veteran experienced PTB within three years of his separation from the military. In this regard, she has submitted a private medical statement from Dr. C., dated in March 2004, in support of her contentions. However, in the statement, Dr. C. indicated that the Veteran was initially diagnosed with costochondritis in February 1947 at the Diaz General Clinic, and was not diagnosed with PTB until June 1956, which is over 10 years after the Veteran's separation from the military. In addition, the evidence of record includes a copy of handwritten treatment notes purportedly from the Diaz General Clinic which also show initial treatment for costochondritis in February 1947, and do not show a diagnosis of PTB until June 1956. With respect to negative evidence, the Court held that the fact that there was no record of any complaint, let alone treatment, involving the Veteran's condition for many years could be highly probative. See Maxson v. West, 12 Vet. App. 453, 459 (1999), affirmed sub nom. Maxson v. Gober, 230 F.3d 1330, 1333 (Fed. Cir. 2000). To the extent that the appellant has submitted statements from Dr. C., dated in March 2004 and August 2007, to show that the Veteran experienced PTB during service and/or within three years from the Veteran's discharge, the Board finds such statements of no probative value. See Madden v. Gober, 125 F. 3d 1477, 1481 (Fed. Cir. 1997); Hayes v. Brown, 5 Vet. App. 60, 69 (1993) ("[i]t is the responsibility of the BVA . . . to assess the credibility and weight to be given the evidence"). In this regard, according to a letter from Dr. C., dated in September 2010, although he had never treated the Veteran, he had summarized the Veteran's medical history based on an old "OPD card" which was lost and could not be found. However, Dr. C. indicated that a Xerox copy of the evidence was available and he re-submitted a copy of the handwritten treatment notes purportedly from the Diaz General Clinic. As stated above, these treatment notes do not show diagnosis and treatment of PTB until June 1956, over 10 years after the Veteran's separation from the military. Thus, the evidence that supposedly supports Dr. C.'s opinion that the Veteran had PTB during service and/or within three years after his discharge, does not actually support such an opinion. Therefore, Dr. C. has not provided any medical records, including x-ray reports, showing treatment for PTB during the Veteran's service and/or within three years of his discharge. Accordingly, he has not explained how he arrived at the PTB diagnosis during the Veteran's service and/or within three years of his discharge, and has provided no supporting clinical data to show that the Veteran had PTB during service and/or within three years of his discharge. As such, to the extent that the statements from Dr. C., dated in March 2004 and August 2007, are submitted to show that the Veteran experienced PTB during service and/or within three years from the Veteran's discharge, the Board finds that such statements are not credible and they have no probative value. The appellant also maintains that one of the causes of the Veteran's death is peptic ulcer disease, which is a POW presumptive disease. She has submitted private medical statements from Dr. C., dated in March 2004 and August 2007, in support of her claim. In the March 2004 statement, Dr. C. indicated that the Veteran had been treated for peptic ulcer disease in June 1956. In the August 2007 statement, Dr. C. specifically noted that at the time of the Veteran's death, he had bleeding peptic ulcer disease which was possibly a principle or contributory cause of his death. However, once again, Dr. C. has not provided any medical records showing that the Veteran experienced peptic ulcer disease at the time of his death in 1973. In the September 2010 letter from Dr. C., he stated that he based his opinion on handwritten treatment notes purportedly from the Diaz General Clinic. However, the Board notes that the aforementioned treatment notes are negative for any complaints or findings of peptic ulcer disease. Records purportedly from the Diaz General Clinic only show treatment for peptic ulcer disease in June 1956. Thus, Dr. C. has not explained how he arrived at his opinion that the Veteran had peptic ulcer disease at the time of his death in 1973, and he has provided no supporting clinical data to show that the Veteran had peptic ulcer disease at the time of his death. Therefore, to the extent that the August 2007 statement from Dr. C. is submitted to show that the Veteran experienced peptic ulcer disease at the time of his death, the Board finds such statement of no probative value. See Madden v. Gober, 125 F. 3d 1477, 1481 (Fed. Cir. 1997); Hayes v. Brown, 5 Vet. App. 60, 69 (1993) ("[i]t is the responsibility of the BVA . . . to assess the credibility and weight to be given the evidence"). The Board also notes that even if the Board accepts as true that the Veteran had peptic ulcer disease at the time of his death, the Board finds Dr. C.'s opinion that the Veteran's peptic ulcer disease was possibly a principle or contributory cause of his death speculative, and a finding of service connection may not be based on a resort to speculation or even remote possibility. See 38 C.F.R. § 3.102 (2011). In addition, the Board notes that peptic ulcer disease is not listed on the Veteran's death certificate. The appellant also maintains that one of the causes of the Veteran's death is beriberi heart disease, which is a POW presumptive disease. However, there is no medical evidence showing a diagnosis of beriberi heart disease, and although the appellant argues the cardiopulmonary disease that caused the Veteran's death was the same as or a result of beriberi heart disease, she does not possess the medical expertise to make such a conclusion. In light of the above, the Veteran's separation examination, dated in February 1946, is negative for any complaints or findings of PTB. The first evidence of record of a diagnosis of PTB is not until June 1956, over 10 years after the Veteran's separation from the military. Moreover, PTB is not listed in 38 C.F.R. § 3.309(c) (for diseases specific as to former POWs). Consequently, the presumptive provisions of 38 U.S.C.A. § 1112 (for chronic diseases and for diseases specific as to former POWs) do not apply. To establish service connection for PTB under these circumstances, the appellant must show affirmatively that the disease was somehow otherwise related to the Veteran's active service. In this regard, the Board notes that there is no credible evidence of record linking the Veteran's PTB to his period of service. The Board has carefully considered the lay statements of record. In this regard, the appellant has maintained that the Veteran's PTB was incurred in service as a result of his POW experiences. She has also contended that the Veteran experienced PTB within three years of his separation from the military. She further maintained that one of the causes of the Veteran's death is peptic ulcer disease. Other lay statements include a lay statement from the Veteran's son, dated in October 2008, in which he stated that one of the causes of the Veteran's death was peptic ulcer disease. In addition, the evidence of record includes lay statements from Ms. A.M. and Ms. F.A., and Mr. T.L., in support of the appellant's claim. Lay assertions may serve to support a claim for service connection by supporting the occurrence of lay-observable events or the presence of disability or symptoms of disability subject to lay observation. 38 U.S.C.A. § 1153(a); 38 C.F.R. § 3.303(a); Jandreau v. Nicholson, 492 F.3d 1371 (2007); see Buchanan v. Nicholson, 451 F.3d 1331 (Fed. Cir. 2006). A layman is competent to report that he or she experiences symptoms as such come through one of the senses. See Layno v. Brown, 6 Vet. App. 465, 470 (1994). In this case, however, whether the Veteran had PTB during service or within three years from his discharge, and whether the Veteran had peptic ulcer disease which was a principle or contributory cause of his death, are complex matters which require specialized training for a determination and are not susceptible of lay opinion. Thus, the aforementioned lay statements cannot be accepted as competent medical evidence and, as such, they lack probative value. In light of the above, the Board finds that there is no credible evidence of record which shows that the Veteran's PTB had its onset during active service or within three years of separation from active service. In addition, there is no credible evidence of record showing a nexus between the Veteran's fatal cardiopulmonary arrest and PTB, and his period of active service. Accordingly, the Board concludes that service connection for the cause of the Veteran's death is not warranted. Although the Veteran certainly encountered terrible conditions as a POW, there is simply no credible evidence here linking his death to his service in any way. In reaching this decision, the Board considered the doctrine of reasonable doubt. However, since the preponderance of the evidence is against the claim, the benefit of the doubt doctrine does not apply and the claim must be denied. 38 U.S.C.A. § 5107(b); Ortiz v. Principi, 274 F.3d 1361, 1364, 1365 (Fed. Cir. 2001) (holding that "the benefit of the doubt rule is inapplicable when the preponderance of the evidence is found to be against the claimant"); Gilbert v. Derwinski, 1 Vet. App. 49 (1990). [Continued on next page] ORDER Entitlement to service connection for the cause of the Veteran's death is denied. ____________________________________________ MICHELLE L. KANE Veterans Law Judge, Board of Veterans' Appeals Department of Veterans Affairs