Citation Nr: 1305693 Decision Date: 02/15/13 Archive Date: 02/21/13 DOCKET NO. 10-21 021 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in Waco, Texas THE ISSUES 1. Entitlement to service connection for colorectal cancer with lung metastasis, claimed as a result of exposure to herbicides, for accrued benefits purposes. 2. Entitlement to service connection for polycythemia vera, claimed as a result of exposure to herbicides, for accrued benefits purposes. 3. Entitlement to service connection for the cause of the Veteran's death. REPRESENTATION Appellant represented by: Texas Veterans Commission WITNESSES AT HEARING ON APPEAL Appellant and L.S. ATTORNEY FOR THE BOARD A. Shawkey, Counsel INTRODUCTION The Veteran served on active duty from February 1956 to April 1959, September 1960 to September 1963, and November 1963 to November 1977, including service in the Republic of Vietnam. He died in November 2008. The appellant is his widow. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a May 2009 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO) in Waco, Texas . In this decision the RO denied entitlement to service connection for colorectal (colon) cancer with lung metastasis and for polycythemia vera, both claimed as due to herbicide exposure, for accrued benefits purposes, as well as denied entitlement to service connection for the cause of the Veteran's death. Although the only issue addressed in the statement of the case is entitlement to service connection for the cause of the Veteran's death, the Board finds that the issues of entitlement to service connection for colorectal cancer with lung metastasis and for polycythemia vera, both claimed as due to herbicide exposure, for accrued benefits purposes, are part and parcel of the cause of death issue and therefore remain on appeal as is reflected on the title page of this decision. The appellant testified at a Board hearing before the undersigned Veterans Law Judge in March 2012. A transcript of the hearing is of record. This matter was previously before the Board in June 2012 at which time it was remanded for additional development. In the June 2012 remand, the Board directed that attempts be made to obtain identified private treatment records and to obtain a VA medical opinion. The record shows that attempts were made in August 2012 to obtain identified private treatment records and a VA medical opinion was obtained in July 2012. Thus, there has been substantial compliance with the Board's July 2012 remand directives. See Stegall v. West, 11 Vet. App. 268 (1998). 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. Colon cancer, with lung metastasis, is not a disease presumed to be associated with Agent Orange/herbicides; it was first manifested years after service and is unrelated to service or a service-connected disability. 2. Polycythemia vera is not a disease presumed to be associated with Agent Orange/herbicides; it was first manifested years after service and is unrelated to service or a service-connected disability. 3. The Veteran died in November 2008, the immediate cause of death was colon cancer; brain metastasis, lung metastasis, chronic obstructive pulmonary disease (COPD), and cerebral vascular accident (CVA) were listed as other significant conditions. 4. Following the Veteran's death, service connection was granted for prostate cancer with residuals erectile dysfunction, rated 0 percent disabling, for accrued benefit purposes. 5. The Veteran's service-connected prostate cancer was not the principal or contributory cause of death. 6. Colon cancer, COPD and CVA were not manifest in service or, in specific regard to colon cancer, within one year of discharge from service. 7. Lung cancer and brain cancer were the result of metastasis from colon cancer. CONCLUSIONS OF LAW 1. The criteria for service connection for colon cancer with lung metastasis, claimed as due to herbicide exposure, for the purposes of accrued benefits, have not been met. 38 U.S.C.A. §§ 1110, 1112, 1131, 5107, 5121 (West 2002); 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309, 3.310, 3.1000 (2012). 2. The criteria for service connection for polycythemia vera, claimed as due to herbicide exposure, for the purposes of accrued benefits, have not been met. 38 U.S.C.A. §§ 1110, 1112, 1131, 5107, 5121 (West 2002); 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309, 3.310, 3.1000 (2012). 3. The criteria for service connection for the cause of the Veteran's death have not been met. 38 U.S.C.A. § 1310 (West 2002); 38 C.F.R. § 3.312 (2012). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS I. Veterans Claims Assistance Act of 2000 The Veterans Claims Assistance Act of 2000 (VCAA), Pub. L. No. 106-475, 114 stat. 2096 (Nov. 9, 2000) (codified at 38 U.S.C.A. §§ 5100, 5102, 5103, 5103A, 5106, 5107, 5126 (West 2002) redefined VA's duty to assist the Veteran in the development of a claim. VA regulations for the implementation of the VCAA were codified as amended at 38 C.F.R. §§ 3.102, 3.156(a), 3.159, 3.326(a) (2012). Under the VCAA, 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; (3) that the claimant is expected to provide; and (4) must request that the claimant provide any evidence in his possession that pertains to the claim. Pelegrini v. Principi, 18 Vet. App. 112, 120-21 (2004); 38 U.S.C.A. § 5103(a);38 C.F.R. § 3.159(b). In the context of a claim for Dependency and Indemnity Compensation (DIC) benefits, which includes a claim of service connection for the cause of the Veteran's death, VCAA notice 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 DIC claim based on a previously service-connected condition; and (3) an explanation of the evidence and information required to substantiate a DIC claim based on a condition not yet service-connected. Hupp v. Nicholson, 21 Vet. App. 342, 352-353 (2007), rev'd on other grounds, Hupp v. Shinseki, 329 Fed. App. 277 (Fed. Cir. May 19, 2009) (unpublished). In letters dated in January 2009, the RO satisfied the notice requirements of Hupp as outlined above. In short, these letters as well as earlier letters dated in December 2008 and October 2008 satisfy VAs duty to inform the claimant under the VCAA with respect to the cause of death and accrued benefits claims. This duty included delineating the evidence VA would assist in obtaining and the evidence it was expected that the appellant would provide. Quartuccio v. Principi, 16 Vet. App. 183, 186-87 (2002); Charles v. Principi, 16 Vet. App. 370 (2002). The United States Court of Appeals for Veterans Claims (Court) has also 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. Dingess/Hartman v. Nicholson, 19 Vet. App. 473 (2006). The Veteran's status as a veteran was substantiated during his lifetime. While the RO has not furnished to the appellant a letter meeting the Dingess/Hartman requirements as to disability rating and effective date, no prejudice is shown to the appellant in this case. Disability ratings are not relevant to a claim for service connection for the cause of a veteran's death and because the Board is denying the appellant's claim, no effective date is being, or is to be, assigned. Accordingly, there is no possibility of prejudice to the appellant under the notice requirements of Dingess/Hartman. The VCAA also requires VA to make reasonable efforts to help a claimant obtain evidence necessary to substantiate his claim. 38 U.S.C.A. § 5103A; 38 C.F.R. § 3.159(c),(d). This "duty to assist" contemplates that VA will help a claimant obtain records relevant to the claim, whether or not the records are in Federal custody, and that VA will provide a medical examination or obtain an opinion when necessary to make a decision on the claim. 38 C.F.R. § 3.159(c)(4). In this case, VA made reasonable attempts to obtain identified medical records pertinent to this claim. Unfortunately, VA was unable to obtain private treatment records from two physicians regarding treatment prior to 1999, see Board remand of June 2012, despite adequate attempts to obtain such evidence. VA did obtain a medical opinion addressing the relationship, if any, between the Veteran's service connected prostate cancer and the cause of his death. This opinion is adequate as the physician who prepared it explained the reasons for his conclusions based on an accurate characterization of the evidence of record and supported his conclusion with an analysis that is adequate for the Board to consider and weigh against any contrary opinions. Stefl v. Nicholson, 21 Vet. App. 120, 124-25 (2007). The Board acknowledges that a VA medical opinion was not obtained in response to the appellant's service connection claims for colon cancer with lung metastasis and polycythemia vera, but has determined that a medical opinion is not required in this case. The medical evidence of record is sufficient to decide the claim and for the reasons given below there is no is no competent evidence of an association between the Veteran's colon cancer with lung metastasis or polycythemia vera and service or a service-connected disability. 38 U.S.C.A. § 5103A(d) (West 2002); see McClendon v. Nicholson, 20 Vet. App. 79, 83 (2006). Also, the appellant presented hearing testimony before the Board in March 2012. For the reasons set forth above, the Board finds that VA has complied with the VCAA's notification and assistance requirements. The claims for service connection for colon cancer with lung metastasis and polycythemia vera, claimed as due to exposure to herbicides, for accrued benefits purposes and for entitlement to service connection for the cause of the Veteran's death are thus ready to be considered on the merits. II. Service Connection Law and Regulations Service connection will be granted for a disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C.A. §§ 1110, 1131; 38 C.F.R. § 3.303(a). Establishing service connection generally requires (1) medical evidence of a current disability; (2) medical or, in certain circumstances, lay evidence of in-service incurrence or aggravation of a disease or injury; and (3) medical evidence of a nexus between the claimed in-service disease or injury and the present disability. Shedden v. Principi, 381 F. 3d 1163, 1167 (Fed. Cir. 2004); Caluza v. Brown, 7 Vet. App. 498, 506 (1995), aff'd per curiam, 78 F. 3d 604 (Fed. Cir. 1996) (table); see generally 38 C.F.R. § 3.303. Under 38 C.F.R. § 3.303(b), an alternative method of establishing the second and third elements is through a demonstration of continuity of symptomatology. See Barr v. Nicholson, 21 Vet. App. 303, 307 (2007). A claimant can establish continuity of symptomatology with competent evidence showing: (1) that a condition was 'noted' during service; (2) post-service continuity of the same symptomatology; and (3) a nexus between a current disability and the post-service symptomatology. Savage v. Gober, 10 Vet. App. 488, 495-96 (1997); 38 C.F.R. § 3.303(b). Service connection is also provided for a disability, which is proximately due to, or the result of a service-connected disease or injury. 38 C.F.R. § 3.310. The Court has held that service connection can be granted under 38 C.F.R. § 3.310, for a disability that is aggravated by a service- connected disability and that compensation can be paid for any additional impairment resulting from the service- connected disorder. Allen v. Brown, 7 Vet. App. 439 (1995). VA has amended 38 C.F.R. § 3.310 to explicitly incorporate the holding in Allen, except that it will not concede aggravation unless a baseline for the claimed disability can be established prior to any aggravation. 38 C.F.R. § 3.310(b). In addition, service connection may be granted for a disease first diagnosed after discharge when all of the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d). For Veterans who served 90 days or more of during a war period, certain chronic disabilities, including malignant tumors, are presumed to have been incurred in service if they manifested to a compensable degree within one year of separation from service. 38 U.S.C.A. §§ 1101, 1112, 1113; 38 C.F.R. §§ 3.307(a), 3.309(a). A veteran, who, during active military service, served in Vietnam during the period beginning in January 1962 and ending in May 1975, is presumed to have been exposed to herbicides. 38 C.F.R. §§ 3.307, 3.309. If a veteran was exposed to an herbicide agent during active military, naval, or air service, the following diseases shall be service-connected even though there is no record of such disease during service: chloracne or other acneform disease consistent with chloracne, Type 2 diabetes, Hodgkin's disease, ischemic heart disease (including, but not limited to, acute, subacute, and old myocardial infarction; atherosclerotic cardiovascular disease including coronary artery disease (including coronary spasm) and coronary bypass surgery; and stable, unstable and Prinzmetal's angina), all chronic B-cell leukemias (including, but not limited to, hairy-cell leukemia and chronic lymphocytic leukemia), multiple myeloma, non-Hodgkin's lymphoma, Parkinson's disease, acute and subacute peripheral neuropathy, porphyria cutanea tarda, prostate cancer, respiratory cancers (cancer of the lung, bronchus, larynx or trachea), and soft-tissue sarcoma (other than osteosarcoma, chondrosarcoma, Kaposi's sarcoma, or mesothelioma). 38 C.F.R. § 3.309(e); 75 Fed. Reg. 53,202 -53,216, 53,205 (Aug. 31, 2010). During the pendency of the appellant's claim and appeal, VA amended 38 C.F.R. § 3.309(e) to include ischemic heart disease. 75 Fed. Reg. 53202 (August 31, 2010). The pertinent part of that amendment added the following to § 3.309(e): "Ischemic heart disease (including, but not limited to, acute, subacute, and old myocardial infarction; atherosclerotic cardiovascular disease including coronary artery disease (including coronary spasm) and coronary bypass surgery; and stable, unstable and Prinzmetal's angina)." 75 Fed. Reg. 53202, 53216 (August 31, 2010). This amended rule applies to claims received by VA on or after August 31, 2010 and to claims pending before VA on that date. 75 Fed. Reg. 53202 (August 31, 2010). Id. The appellant's claim was pending before VA on that date. Notwithstanding the foregoing presumptions, a claimant is not precluded from establishing service connection with proof of direct causation. 38 U.S.C.A. § 1113(b); Combee v. Brown, 34 F. 1039, 1042 (Fed. Cir. 1994). The Board is responsible for evaluating the evidence of record and assigning due probative weight. Madden v. Gober, 125 F. 3d 1477, 1481 (Fed. Cir. 1997); see also Washington v. Nicholson, 19 Vet. App. 362, 267-68 (2005); Owens v. Brown, 7 Vet. App. 429, 433 (1995). Upon weighing the evidence, if there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, the Secretary shall give the benefit of the doubt to the claimant. 38 U.S.C.A. § 5107; 38 C.F.R. § 3.102; Gilbert v. Derwinski, 1 Vet. App. 49, 53 (1990). III. Analysis A. Service Connection for Colon Cancer with Lung Metastasis and Polycythemia Vera, For Accrued Benefits Purposes Periodic monetary benefits to which a Veteran was entitled at death under existing ratings or decisions, or those based on evidence in the file at the date of death, and due and unpaid, shall be paid to the surviving spouse. 38 U.S.C.A. § 5121; 38 C.F.R. § 3.1000(a). Evidence in the file at date of death means evidence in VA's possession on or before the date of the beneficiary's death, even if such evidence was not physically located in the VA claims folder on or before the date of death, in support of a claim for VA benefits pending on the date of death. 38 C.F.R. § 3.1000(d)(4). A claim for VA benefits pending on the date of death means a claim filed with VA that had not been finally adjudicated by VA on or before the date of death. 38 C.F.R. § 3.1000(d)(5). The appellant contends that the Veteran was entitled to service connection for colon cancer with lung metastasis and polycythemia vera, due to herbicide exposure, based on the evidence of record at the time of his death. Thus, the provisions of 38 C.F.R. §§ 3.307 and 3.309 warrant consideration which, as noted above, allow for service connection on a presumptive basis, without additional evidence of a link between service and the currently diagnosed disability, where a Veteran served on active duty in the Republic of Vietnam during the Vietnam era and the currently diagnosed disorder is among the presumptive disabilities enumerated under 38 C.F.R. § 3.309(e). The Veteran's service records confirm that he served on active duty in Vietnam and his exposure to herbicide agents is thus presumed. However, as neither colon cancer nor polycythemia vera are among the listed presumptive disabilities for exposure to herbicide agents, presumptive service connection under 38 C.F.R. §§ 3.307 and 3.309(e) is not applicable to these claims. Furthermore, although lung cancer is on the list of presumptive disabilities, as the medical evidence outlined below indisputably shows, the Veteran's lung cancer metastasized from his colon cancer and was not the primary site. Thus, presumptive service connection under 38 C.F.R. §§ 3.307 and 3.309 for the Veteran's lung metastasis is also not applicable. As noted, the availability of presumptive service connection for a disability based on exposure to herbicides does not preclude a Veteran from establishing service connection with proof of direct causation. Stefl v. Nicholson, 21 Vet. App. 120 (2007); see also Combee v. Brown, 34 F. 3d 1039 (Fed. Cir. 1994). The Veteran's service treatment records are devoid of treatment for or diagnoses of colon cancer with lung metastasis and polycythemia vera. Rather, postservice medical records reflect diagnoses of colon cancer with lung metastasis and polycythemia many years after service. More specifically, the medical records show that the Veteran was found to have a rectal mass in April 2004 and was diagnosed as having colon cancer in June 2004. In May 2005, he was found to have metastatic colorectal adenocarcinoma to the lung. In regard to polycythemia vera, the date of onset of this disability is unclear. The appellant contends that the Veteran was found to have this blood disorder at the time of his CVA in 1994. Unfortunately, as outlined above, treatment records from 1994 could not be obtained. With that said, the earliest medical record on file reflecting a diagnosis of polycythemia vera is dated in May 2000. In short, the Veteran was found to have polycythemia vera and colon cancer with lung metastasis many years after service and there is no argument to the contrary. Accordingly, as there is no claim or showing of these disabilities since service or continuity of symptomtology after service, service connection under the provisions of 38 C.F.R. § 3.303(b) has not been established. As far as the provisions of 38 C.F.R. § 3.303(d) regarding establishing a medical nexus, the only evidence relating the Veteran's postservice colon cancer with lung metastasis and polycythemia vera to service, including exposure to herbicide agents, is the appellant's assertions in this regard. Although lay witnesses may, in some circumstances, opine on questions of diagnosis and etiology, see Davidson v. Shinseki, 581 F 3d 1313, 1316 (Fed. Cir. 2009) (Board's categorical statement that "a valid medical opinion" was required to establish nexus, and that a layperson was "not competent" to provide testimony as to nexus because she was a layperson, conflicts with Jandreau v. Nicholson, 492 F. 3d 1372, 1376-66 (Fed.Cir.2007)), this matter appears to be the type of medical matter as to which the courts have held lay testimony is not competent. Thus, based on the facts of this case, the appellant is not competent to render an opinion as to the cause or etiology of the Veteran's colon cancer with lung metastasis or polycythemia vera as such matters require medical expertise which the appellant is not shown to possess. See Jandreau, 492 F. 3d at 1376-77 (noting general competence to testify as to symptoms but not to provide medical diagnosis); see also Clyburn v. West, 12 Vet. App. 296 (1999). In addressing all pertinent theories of entitlement to service connection, consideration has been given to these claims on a secondary basis. That is, whether the Veteran's colon cancer with lung metastasis and polycythemia are proximately related to or caused by his service-connected prostate cancer. 38 C.F.R. § 3.310. This matter was addressed by a VA examiner in July 2012 who negated such a nexus. More specifically, the July 2012 VA examiner stated that in regard to the development of polycythemia (PV), this condition was one of the chronic myeloproliferation disorders (neoplasms) collectively characterized by clonal proliferation of myeloid cells with variable morphologic maturity and hematopoietic efficiency. He went on to report that prostate cancer was not a recognized risk factor for the development of PV. He also stated that the prostate cancer was unlikely to have caused or contributed to the development of the Veteran's other disabilities, to include colon cancer and polycythemia vera. He said these issues were all separate from the prostate cancer, and prostate cancer was not a recognized risk factor for the development of any of them. With respect to the appellant's assertions that the Veteran's colon cancer with lung metastasis and polycythemia are secondary to his prostate cancer, as discussed above, such a matter requires medical expertise which the appellant is not shown to possess. See Jandreau, 492 F. 3d at 1376-77 (noting general competence to testify as to symptoms but not to provide medical diagnosis); see also Clyburn v. West, 12 Vet. App. 296 (1999). Thus, her opinion in this regard is not considered competent evidence. In sum, with respect to the claims for service connection for colon cancer with lung metastasis and for polycythemia vera, claimed as due to exposure to herbicides, for accrued benefits purposes, the Board finds that the third essential criterion for a grant of service connection-a causal relationship between the post active duty disabilities and a disease or injury incurred or aggravated during active service-has not been met in this case. 38 C.F.R. § 3.303; Shedden, supra. Because the competent evidence neither supports the claim, nor is in relative equipoise on this question, the benefit-of-the-doubt doctrine is not for application and the claims for service connection for colon cancer with lung metastasis and for polycythemia vera, claimed as due to exposure to herbicides, for accrued benefits purposes, must be denied. See 38 U.S.C.A. § 5107(b). B. Service Connection for the Cause of the Veteran's Death Under 38 U.S.C.A. § 1310, when a veteran dies from a service related disability, VA will pay dependency and indemnity compensation (DIC) to such veteran's surviving spouse. To establish that a veteran died from a service related disability, i.e., service connection for the cause of death, the evidence must show that a disability that was incurred in or aggravated by service was either a principal or contributory cause of death. 38 C.F.R. § 3.312. For a service-connected disability to be the principal cause of death, it must singularly or jointly with some other condition be the immediate or underlying cause of death, or be etiologically related thereto. 38 C.F.R. § 3.312(b). For a service-connected disability to be a contributory cause of death, it must be shown that it contributed substantially or materially, that it combined to cause death, or aided or lent assistance to the production of death. In this regard, it is not sufficient to show that the service-connected disability casually shared in producing death; rather, it must be shown that there was a causal connection. 38 C.F.R. § 3.312(c)(1). In the instant case, the Veteran's death certificate shows that the immediate cause of death was colon cancer. Brain metastasis, lung metastasis, COPD, and CVA are listed as other significant conditions contributing to death but not resulting in the underlying cause. The certificate also shows that an autopsy was not performed. Following the Veteran's death, service connection was granted in May 2009 for prostate cancer with residuals erectile dysfunction, rated 0 percent disabling, for accrued benefit purposes. By way of background, the record shows that the Veteran underwent testing in December 2000 due to complaints of hematuria off and on and was found in January 2001 to have muscle invasive bladder cancer. In February 2001, he underwent cystoprostectomy and ileal conduit for advanced bladder cancer. At that time he was also found to have an "incidentally detected Gleason 7 prostate cancer". See May 2008 Consult Report from East Texas Medical Center (ETMC) Cancer Institute. The Veteran thereafter received chemotherapy for pathologic T3 disease. His prior noted medical history was significant for polycythemia vera, COPD and CVA. Records date the CVA to 1994. See History and Physical Report from Tyler Urology Associates dated in December 2000. The earliest diagnosis of polycythemia vera and of COPD is reflected on a private treatment record dated in May 2000. In April 2004, the Veteran was found to have a rectal mass and was diagnosed in June 2004 as having colon cancer. He underwent a colon resection in June 2004. In May 2005, he was found to have metastatic colorectal adenocarcinoma to the lung with three slowly progressing lung masses. While preparing to do CyberKnife on one of the masses, a brain magnetic resonance imaging was performed in July 2008 revealing that the Veteran had brain cancer. Radiation (3,000 cGy in 10 fractions) was administered over 13 days. The Veteran was put on hospice and died at home in November 2008. During the March 2012 Board hearing and in a statement submitted at the hearing, the appellant asserted that the service-connected prostate cancer, suffered by the Veteran before the incurrence of the disease that ultimately led to his death, substantially contributed to his death. The appellant contends that the prostate cancer significantly diminished the Veteran's ability to fight the diseases that he later incurred. In July 2012, the Board obtained a VA medical opinion addressing whether the Veteran's prostate cancer contributed to the cause of his death, to include whether it rendered him less capable of resisting the conditions that caused his death. After reviewing the Veteran's claims file, the VA examiner stated that in regard to the development of polycythemia (PV), this condition was one of the chronic myeloproliferation disorders (neoplasms) collectively characterized by clonal proliferation of myeloid cells with variable morphologic maturity and hematopoietic efficiency. He went on to report that prostate cancer was not a recognized risk factor for the development of PV. He further noted that the Veteran had multiple neoplasms identified as bladder, prostate, PV, and metastatic colorectral cancer. He said that clearly the most important cancer contributing to the Veteran's death was the metastatic colorectal cancer. He explained that the prostate cancer was an incidental finding, and did not contribute significantly to the Veteran's death, either directly or indirectly. He also stated that the prostate cancer was unlikely to have caused or contributed to the development of the bladder cancer, PV, colon cancer, COPD or CVA. He said these issues were all separate from the prostate cancer, and prostate cancer was not a recognized risk factor for the development of any of them. He opined that the prostate cancer did not hasten the Veteran's death or render him less capable of resisting the conditions that caused death. He added that in the Veteran's case, the prostate cancer was a relatively minor incidental condition, when compared with his other, "overwhelming medical conditions." In addressing the appellant's contentions outlined above, the VA examiner in July 2012 clearly negates, with rational, that the Veteran's prostate cancer led to the development of polycythemia and a stroke. He also clearly negates, with rational, the assertion that the prostate cancer significantly diminished the Veteran's ability to fight the diseases that he later incurred. Thus, as the VA examiner gave adequate reasoning for his conclusions based on an accurate characterization of the evidence of record and specifically considered the appellant's arguments of a nexus, his opinion negating that the Veteran's prostate cancer contributed to the cause of his death is entitled to substantial probative weight. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008) (most of the probative value of a medical opinion comes from its reasoning). Moreover, there is no medical evidence to the contrary. Rather, the appellant acknowledged at the hearing in March 2012 that the Veteran's doctor, Dr. Droder, told her that the Veteran's colon cancer (with metastasis to the lung and brain) had nothing to do with the bladder or prostate cancer. Finally, there is no evidence or argument that the immediate or contributory cause of death was itself related to service. In determining whether the disability that resulted in the death of the Veteran was the result of active service, the standards and criteria applicable to service connection claims generally are to be applied. See 38 U.S.C.A. § 1310(a). There are no notations regarding the causes of the Veteran's death as listed on his death certificate i.e., colon cancer, brain metastasis, lung metastasis, COPD and CVA, in the service treatment records. Rather, as shown, postservice medical records show that such disabilities, namely, colon cancer, COPD and CVA were discovered decades after service and, with respect to his brain metastasis and lung metastasis, just months prior to the Veteran's death. Thus, as there is no evidence that these disabilities manifested within the one year presumptive period or that they are otherwise related to service, service connection for the cause of death must be denied on this basis. 38 C.F.R. § 3.303. Regarding herbicide exposure, as noted, the Board concedes that the Veteran had herbicide exposure. 38 C.F.R. §§ 3.307, 3.309. However, the disabilities listed on the Veteran's Death Certificate, i.e., colon cancer, brain metastasis, lung metastasis, COPD and CVA, are not on the list of presumptive diseases due to herbicide exposure. Although respiratory cancers to include the lung are on the list, the medical evidence of record clearly shows that the Veteran's lung metastasis was of colonic origin. See University of Texas Health Center Surgical Pathology Report of October 2005. In short, the disabilities listed on the Veteran's death certificate are not subject to herbicide presumptive service connection. Moreover, as far as medical evidence relating the Veteran's fatal conditions with herbicide exposure on a direct basis, see Combee, supra, there is no such evidence. Notably, the appellant acknowledged at the March 2012 Board hearing that no one had ever told her that the Veteran's colon cancer could have been related to the Veteran's service in Vietnam and Agent Orange. The Board has carefully considered the appellant's lay statements that the Veteran's death is related to his service-connected prostate cancer and/or to exposure to Agent Orange in service. 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. Jandreau v. Nicholson, 492 F. 3d 1371 (2007); see also 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 cause of death is related to service requires specialized training for a determination and is not susceptible of lay opinion. The appellant's statements alone cannot be accepted as competent medical evidence. A professional has the greater skill. No professional, to include the Veteran's treating physician, has proposed any connection between service and the cause of death. Rather, the only competent and/or probative evidence in the record is the July 2012 VA opinion which militates against the appellant's claim. Accordingly, the preponderance of the evidence is against the claim for service connection for the cause of the Veteran's death. The benefit-of-the-doubt doctrine is therefore not for application, and the claim must be denied. See 38 U.S.C.A. § 5107(b);38 C.F.R. § 3.102; Fagan v. Shinseki, 573 F. 3d 1282, 1287 (Fed. Cir. 2009). ORDER Entitlement to service connection for colorectal cancer with lung metastasis, claimed as a result of exposure to herbicides, for accrued benefits purposes, is denied. Entitlement to service connection for polycythemia vera, claimed as a result of exposure to herbicides, for accrued benefits purposes, is denied. Entitlement to service connection for the cause of the Veteran's death is denied. ____________________________________________ Cheryl L. Mason Veterans Law Judge, Board of Veterans' Appeals Department of Veterans Affairs