Citation Nr: 1306334 Decision Date: 02/25/13 Archive Date: 03/01/13 DOCKET NO. 10-08 421A ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in Manchester, New Hampshire THE ISSUES 1. Entitlement to service connection for the cause of the Veteran's death. 2. Entitlement to accrued benefits. REPRESENTATION Appellant represented by: Disabled American Veterans WITNESSES AT HEARING ON APPEAL Appellant and her daughter-in-law ATTORNEY FOR THE BOARD N. T. Werner, Counsel INTRODUCTION The Veteran served on active duty from June 1972 to October 1972 and from January 1973 to December 1976. The Veteran also had a subsequent unverified period of service with a reserve component. The Veteran died in October 2007. The appellant is the Veteran's widow. This matter comes to the Board of Veterans' Appeals (Board) on appeal from a March 2009 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO) in Manchester, New Hampshire. In September 2012, the appellant and her daughter-in-law testified at a video hearing before the undersigned Veterans Law Judge. A transcript of the hearing has been associated with the claims file. Following the hearing, the widow filed with the Board additional medical evidence in support of her appeal along with waiver of agency of original jurisdiction (AOJ) review. Therefore, the Board finds that VA adjudication of the current appeal may go forward without first remanding it for a supplemental statement of the case. See 38 C.F.R. § 20.1304(c) (2012). In August 2008 and again in May 2009, the claimant attempted to file a claim for nonservice-connected burial benefits (characterized as a claim for $300 for the Veteran's cemetery plot). This claim does not appear to have been adjudicated by the Agency of Original Jurisdiction (AOJ). Therefore, the Board does not have jurisdiction over it and it is referred to the AOJ for appropriate action. FINDINGS OF FACT 1. The most competent and credible evidence of record does not show that the Veteran had service or had other duty or visitation in the Republic of Vietnam during the Vietnam Era. 2. The most competent and credible evidence of record does not show that the Veteran had exposure to Agent Orange or other herbicide agents during his military service. 3. The most competent and credible evidence of record is against a finding that any of the diseases that caused or contributed materially or substantially to the Veteran's death are related to his military service or may be presumed to have been incurred in service. 4. The most competent and credible evidence of record does not show that a service-connected disability caused or contributed materially or substantially to the Veteran's death. 5. The Veteran did not have an appeal pending for service connection for any disorder at the time of his death. CONCLUSIONS OF LAW 1. A service-connected disability did not cause or contribute substantially or materially to the cause of the Veteran's death. 38 U.S.C.A. §§ 101, 106, 1101, 1110, 1112, 1113, 1116, 1131, 1310, 5100, 5102, 5103, 5103A, 5107 (West 2002 & Supp. 2011); 38 C.F.R. §§ 3.102, 3.159, 3.303, 3.307, 3.309, 3.312 (2012). 2. The criteria for entitlement to accrued benefits have not been met. 38 U.S.C.A. §§ 5101(a), 5121(a) (West 2002); 38 C.F.R. § 3.1000 (2012). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veterans Claims Assistance Act of 2000 (VCAA) The VCAA describes VA's duty to notify and assist claimants in substantiating a claim for VA benefits. See 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). Under 38 U.S.C.A. § 5102 VA first has a duty to provide an appropriate claim form, instructions for completing it, and notice of information necessary to complete the claim if it is incomplete. Second, under 38 U.S.C.A. § 5103(a), VA has a duty to notify the claimant of the information and evidence needed to substantiate and complete a claim, i.e., existence of a current disability, the degree of disability, and the effective date of any disability benefits. The appellant must also be notified of what specific evidence she is to provide and what evidence VA will attempt to obtain. VA thirdly has a duty to assist claimants in obtaining evidence needed to substantiate a claim. This includes obtaining all relevant evidence adequately identified in the record and, in some cases, obtaining a medical opinion. 38 U.S.C.A. § 5103A. In Dingess v. Nicholson, 19 Vet. App. 473, 490 (2006), the United States Court of Appeals for Veterans Claims (Court) observed that a claim of entitlement to service connection consists of five elements, of which notice must be provided prior to the initial adjudication: (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. See 38 U.S.C. § 5103(a). In claims of service connection for the cause of the Veteran's death, the Court in Hupp v. Nicholson, 21 Vet. App. 342 (2007) held that VA's 38 U.S.C.A. § 5103(a) notice requirements also includes (1) a statement of the conditions, if any, for which a Veteran was service-connected at the time of his 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. As to the claim for accrued benefits, while the VCAA is potentially applicable to a great number of claims, the Board finds that it is not applicable to the current claim because the law and not the evidence is dispositive in this claim. Sabonis v. Brown, 6 Vet. App. 426, 430 (1994) (where the law and not the evidence is dispositive, the Board should deny the claim on the ground of lack of legal merit); See also Dela Cruz v. Principi, 15 Vet. App. 143, No. 99-158 (2001) (holding that remand pursuant to the VCAA is not required where "no reasonable possibility exists that any further assistance would aid the appellant in substantiating her claim"); Smith (Claudus) v. Gober, 14 Vet. App. 227 (2000) (holding that when the VCAA does not affect the issues to be decided, the Court will not consider the VCAA in reaching its decision). Therefore, the Board finds that further discussion of the VCAA is not required as to the claim for accrued benefits. As to the cause of death claim, the Board notes that in the current appeal there is no issue as to providing an appropriate application form, completeness of the application, or the decedent's veteran status. Next, the Board finds that written notice provided in September 2008 and November 2008, prior to the March 2009 rating decision, fulfills the provisions of 38 U.S.C.A. § 5103(a). While Hupp notice was not provided to the claimant, the Board finds this lack of notice harmless error because the Veteran was not service connected for any disability during his lifetime. Furthermore, even if the above letters did not provided adequate 38 U.S.C.A. § 5103(a) notice, the Board finds that this notice problem does not constitute prejudicial error in this case because the record reflects that a reasonable person could be expected to understand what was needed to substantiate the claim after reading the above letters as well as the rating decision and the statement of the case. See Shinseki v. Sanders, 129 S.Ct. 1696 (2009). In Bryant v. Shinseki, 23 Vet. App. 488 (2010), the Court held that 38 C.F.R. § 3.103(c)(2) (2010) requires that the Veterans Law Judge (VLJ) who conducts a hearing fulfill two duties to comply with the above regulation. These duties consist of (1) the duty to fully explain the issues and (2) the duty to suggest the submission of evidence that may have been overlooked. Here, during the September 2012 Board hearing the claimant was assisted at the hearing by an accredited representative and the representative and the VLJ asked questions to ascertain the extent of any in-service event or injury and whether any of the diseases that caused the Veteran's death were related to his service. No pertinent evidence that might have been overlooked and that might substantiate the claim was identified by the appellant or the representative that was not already obtained or which is not available for reasons explained below. The hearing focused on the elements necessary to substantiate the claim and the appellant, through her testimony, demonstrated that she had actual knowledge of the elements necessary to substantiate her claim. Therefore, the Board finds that, consistent with Bryant, the VLJ complied with the duties set forth in 38 C.F.R. § 3.103(c)(2). VA has also secured all available pertinent evidence and conducted all appropriate development. Specifically, the record shows that the RO has obtained and associated with the claims file all identified and available service and post-service medical records including the service treatment records and the post-service records from Hershey Medical Center, Pinnacle Health, Elliot Hospital and Cancer Center, Manchester Kidney Center, Three Rivers, Genesis Medical Center, and Hazelton General Hospital. Initially, the Board notes that the claims file does not include the Veteran's service personnel records. Nonetheless, the Board finds that a remand to obtain and associate with the claims file these records is not required because in December 2008 the National Personnel Records Center (NPRC) already notified the RO that there is no evidence in the Veteran's file to substantiate any service in the Republic of Vietnam. Next, the Board notes that the record does not contain the records that the widow reported were held by Dr. Alfonso Roadriquez, Urological Associates, St. Mary's Hospital, Fresinus Dialysis Center, Harrisburg PA Hospital, Geisinger Medical Center, and an ENT in Hilton. See June 2009 statement in support of claim. Nonetheless, the Board finds that a remand to request these records is not required. As to Dr. Roadriquez's records, the Board has reached this conclusion because in December 2008 the RO notified her that these records were not received despite the RO's request and adjudication of her claim would go forward without them unless she obtained them. As to the other records, the Board has reached this conclusion because she did not provide the RO with authorizations to request these records despite being informed of the need to do so in the earlier September 2008 and November 2008 VCAA letters. See Wood v. Derwinski, 1 Vet. App. 190, 192 (1991) (holding that "the duty to assist is not always a one-way street. If a veteran (appellant) wishes help, he cannot passively wait for it in those circumstances where he may or should have information that is essential in obtaining the purtative evidence."). In the September 2010 VA Form 9 as well as at her personal hearing the appellant notified VA that a number of the Veteran's doctors told her that the cancers that caused his death were caused by his exposure to Agent Orange while stationed in the Republic of Vietnam. However, the record does not show that VA ever specifically asked the widow for authorizations to obtain these opinions. Nonetheless, the Board finds that a remand to request these opinions is not required because treatment records already obtained from Pinnacle Health, Elliot Hospital and Cancer Center, and Hazelton General Hospital contains the referenced opinions. The Board recognizes that VA did not obtain a medical opinion as to the origins or etiology of the disease processes that caused the Veteran's death. In this regard, the Federal Circuit has addressed the appropriate standard to be applied in determining whether obtaining an opinion is needed. In Waters v. Shinseki, 601 F.3d 1274 (Fed. Cir. 2010) and Colantonio v. Shinseki, 606 F.3d 1378 (Fed. Cir. 2010), the Federal Circuit held that while there must be "medically competent" evidence of a current disability, "medically competent" evidence is not required to indicate that the current disability may be associated with service. Colantonio, 606 F.3d at 1382; Waters, 601 F.3d at 1277. On the other hand, a conclusory generalized lay statement suggesting a nexus between a current disability and service would not trigger the requirement to obtain a medical opinion as this would, contrary to the intent of Congress, result in medical examinations being "routinely and virtually automatically" provided to all veterans claiming service connection. Waters, 601 F.3d at 1278-1279. Given the above standard, the Board finds that a remand for a VA opinion is not required because the Veteran did not have service in the Republic of Vietnam or verified herbicide exposure for reasons that will be explained below; service treatment records are negative for the claimed disorders; the post-service record is negative for the claimed disorders for decades after the Veteran's separation from military service; the Board finds the lay statements from the widow and others regarding a nexus between the disabilities that caused the Veteran's death and his service conclusory generalized statements for reasons that will be explained below; and the widow has not alleged continuity of symptomatology. Also see Bardwell v. Shinseki, 24 Vet. App. 36 (2010) (holding that VA was not required to provide a medical examination when there is no credible evidence of an event, injury, or disease in service when the Board does not find his statements credible); McLendon v. Nicholson, 20 Vet. App. 79 (2006). In summary, the facts relevant to this appeal have been properly developed and there is no further action to be undertaken to comply with the provisions of 38 U.S.C.A. §§ 5103(a), 5103A or 38 C.F.R. § 3.159. Therefore, the claimant will not be prejudiced as a result of the Board proceeding to the merits of the appeal. See Bernard v. Brown, 4 Vet. App. 384, 392-94 (1993). In adjudicating the claim below, the Board has reviewed all of the evidence in the claims file including those found in virtual VA. Although the Board has an obligation to provide adequate reasons and bases supporting this decision, there is no requirement that all the evidence submitted by the claimant or obtained on her behalf be discussed in detail. Rather, the Board's analysis below will focus specifically on what evidence is needed to substantiate the claim and what the evidence in the claims files shows, or fails to show, with respect to the claim. See Gonzales v. West, 218 F.3d 1378, 1380-81 (Fed. Cir. 2000); Timberlake v. Gober, 14 Vet. App. 122, 128-30 (2000). The Cause of Death Claim The appellant testified that she was married to the Veteran since he entered military service until the time of his death and that he told her that while stationed at Fort Leonard Wood in 1972 or 1973 he had temporary duty assignments to the Republic of Vietnam. The claimant and her daughter-in-law also testified that after returning from the Republic of Vietnam the Veteran started teaching the children/grand children Vietnamese. The widow also testified that his exposure to Agent Orange while in the Republic of Vietnam caused the cancers that caused his death. In this regard, the widow also testified that starting in 1997 and continuing to the time of his death in 2007, the Veteran was diagnosed and treated for, among other things, cardiovascular renal disease, end stage renal disease, colon polyps, a thyroid mass, a tongue lesion, check cancer, and lymph nodes. She also testified that a 1997 kidney biopsy revealed Agent Orange residue but this biopsy report was no longer available. She also claimed that a number of the Veteran's doctors told her that his cancers were caused by Agent Orange exposure. In order to establish service connection for the cause of the Veteran's death, the evidence must show that a disease or disability incurred in or aggravated by service either caused or contributed substantially or materially to cause death. 38 U.S.C.A. § 1310; 38 C.F.R. § 3.312(a). In determining whether a service-connected disability contributed to death, it must be shown that it contributed substantially or materially; that it combined to cause death; that it aided or lent assistance to the production of death. 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 C.F.R. § 3.312(c)(1). In evaluating the evidence in any given appeal, it is the responsibility of the Board to weigh the evidence and decide where to give credit and where to withhold the same and, in so doing, accept certain medical opinions over others. Schoolman v. West, 12 Vet. App. 307, 310-11 (1999). In this regard, the Board has been charged with the duty to assess the credibility and weight given to evidence. Davidson v. Shinseki, 581 F. 3d 1313 (Fed. Cir. 2009); Jandreau v. Nicholson, 492 F. 3d 1372 (Fed. Cir. 2007); Buchanan v. Nicholson, 451 F. 3d 1331 (Fed. Cir. 2006); Charles v. Principi, 16 Vet. App. 370 (2002); Klekar v. West, 12 Vet. App. 503, 507 (1999); Wood v. Derwinski, 1 Vet. App. 190, 193 (1991). Indeed, the Court has declared that in adjudicating a claim, the Board has the responsibility to do so. Bryan v. West, 13 Vet. App. 482, 488-89 (2000); Wilson v. Derwinski, 2 Vet. App. 614, 618 (1992). In doing so, the Board is free to favor one medical opinion over another, provided it offers an adequate basis for doing so. Evans v. West, 12 Vet. App. 22, 30 (1998); Owens v. Brown, 7 Vet. App. 429, 433 (1995). Initially, the Board notes that the October 2007 Certificate of Death reports that the immediate cause of the Veteran's death was bioccipital hemorrhage and the other significant conditions contributing to his death were cancer of the head and neck, pulmonary nodule, and end stage renal disease. However, the record shows that the Veteran was not service connected for any disability during his lifetime. Accordingly, the Board finds that the widow can only prevail on her current appeal if the record shows that the Veteran should have been service connected during his lifetime for any of the above disabilities that directly caused or materially contributed to his death. 38 U.S.C.A. § 1310; 38 C.F.R. § 3.312. In this regard, the Board notes that service connection is warranted where the evidence of record establishes that a particular injury or disease resulting in disability was incurred in the line of duty in the active military service or, if pre-existing such service, was aggravated thereby. 38 U.S.C.A. §§ 1110, 1131; 38 C.F.R. § 3.303. Additionally, service connection may be granted for disability resulting from disease or injury incurred or aggravated while performing active duty for training (ACDUTRA) or (generally) from injury incurred or aggravated while performing inactive duty training (INACDUTRA). 38 U.S.C.A. §§ 101(24), 106, 1110. If a condition noted during service is not shown to be chronic, then generally a showing of continuity of symptomatology after service is required for service connection. 38 C.F.R. § 3.303(b). In addition, service connection may also be granted on the basis of a post-service initial diagnosis of a disease, where all the evidence establishes the disease was incurred in service. 38 C.F.R. § 3.303(d). Other specifically enumerated disorders, including a brain hemorrhage, brain thrombosis, calculi of the kidney, cardiovascular renal disease including hypertension, diabetes mellitus, leukemia, and malignant tumors including of the brain, spinal cord, and peripheral nerves, will be presumed to have been incurred in service if they manifested to a compensable degree within the first year following separation from active duty. 38 U.S.C.A. §§ 1101, 1112, 1113 (West 2002); 38 C.F.R. §§ 3.307, 3.309. In order to establish service connection for the claimed disorder, there must be evidence of (1) a current disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) of a nexus between the claimed in-service disease or injury and the current disability. See Hickson v. West, 12 Vet. App. 247, 253 (1999). The requirement of a current disability is "satisfied when a claimant has a disability at the time a claim for VA disability compensation is filed or during the pendency of that claim." See McClain v. Nicholson, 21 Vet. App. 319, 321 (2007). Active military, naval, or air service includes any period of ACDUTRA during which the individual concerned was disabled or died from a disease or injury incurred in or aggravated in line of duty, or any period of INACDUTRA during which the individual concerned was disabled or died from injury incurred in or aggravated in line of duty. 38 U.S.C.A. §§ 101(21) and (24); 38 C.F.R. §§ 3.6(a) and (d). ACDUTRA is, inter alia, full-time duty performed by member of the National Guard of any State. 38 C.F.R. § 3.6(c)(3). With regard to herbicide exposure, VA laws and regulations provide that a veteran who, during active military, naval, or air service, served in the Republic of Vietnam during the Vietnam war (i.e., January 9, 1962, to May 7, 1975), shall be presumed to have been exposed to an herbicide agent, unless there is affirmative evidence to the contrary. 38 U.S.C.A. § 1116(a)(3); 38 C.F.R. § 3.307(a)(6)(iii). 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 served in the Republic of Vietnam during the Vietnam war period. 38 C.F.R. § 3.307. For these Vietnam war Veterans, diseases associated with exposure to certain herbicide agents will be presumed to have been incurred in service even though there is no evidence of that disease during the period of service at issue. 38 U.S.C.A. § 1116; 38 C.F.R. §§ 3.307, 3.309. The list of diseases associated with exposure to certain herbicide agents is as follows: AL amyloidosis; chloracne or other acneform disease consistent with chloracne; Type 2 diabetes (also known as Type II diabetes mellitus or adult-onset diabetes); Hodgkin's disease; ischemic heart disease, all chronic B-cell leukemias; 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. 38 C.F.R. § 3.309(e). In essence, if the Veteran did not serve in the Republic of Vietnam during the Vietnam era, actual exposure to herbicides must be verified through appropriate service department or other sources, including credible lay evidence, in order for the presumption of service connection for a herbicide-related diseased under 38 C.F.R. § 3.309(e) to be applicable. Exposure to herbicides is not presumed in such instances. However, once exposure to herbicides has been established by the evidence of record, the presumption of service connection found in 38 C.F.R. § 3.309(e) for herbicide-related diseases is applicable. As reported above, the widow testified that she was married to the Veteran since he entered military service until the time of his death and that he told her that while stationed at Fort Leonard Wood in 1972 or 1973 he had temporary duty assignments to the Republic of Vietnam. The claimant and her daughter-in-law also testified that the Veteran, after returning from the Republic of Vietnam, started teaching the children/grand children Vietnamese. However, in December 2008 the NPRC notified the RO that there is no evidence in the Veteran's file to substantiate any service in the Republic of Vietnam. Likewise, his service treatment records are negative for any evidence of service in the Republic of Vietnam. The Board finds that the clamant and her daughter-in-law are both competent and credible to report on what they see and hear such as the Veteran claiming to have been sent to the Republic of Vietnam and thereafter talked to them about the experience and teaching the children Vietnamese. See Davidson, supra; Buchanan, supra; Jandreau, supra; Charles, supra. However, the Board finds that the official finding by the NPRC that the Veteran did not have any service in the Republic of Vietnam is of greater probative value than the contrary claims by the widow and her daughter-in-law. This is because NPRC is an official government agency charged with having this information and the claimant has not alleged, much less shown, clear evidence to the contrary. See Mindenhall v. Brown, 7 Vet. App. 271 (1994) (holding that there is a "presumption of regularity" under which it is presumed that government officials have properly discharged their official duties, unless there is clear evidence to the contrary.) Accordingly, the Board finds that the most competent and credible evidence of record shows that the Veteran did not serve in the Republic of Vietnam during the Vietnam Era. Therefore, he is not presumed to have been exposed to Agent Orange in service, and any service connection presumption based on that exposure is not applicable. In view that, in order to prevail on her claim that any of the disease process that the Certificate of Death listed as causing or contributing to his death, or any other disability, was caused by his herbicide exposure while on active duty, she must prove that he had actual herbicide exposure. No evidence of this sort is of record. Further, the record does not show that any of the disease process that the Certificate of Death listed as causing or contributing to his death (i.e., bioccipital hemorrhage, cancer of the head and neck, pulmonary nodule, and end stage renal disease) occurred while on active duty. Therefore, the Board finds that entitlement to service connection for the disease process that the Certificate of Death listed as causing or contributing to the Veteran's death (i.e., bioccipital hemorrhage, cancer of the head and neck, pulmonary nodule, and end stage renal disease) is not warranted. 38 U.S.C.A. §§ 1110, 1131; 38 C.F.R. § 3.303(a). In reaching this conclusion, the Board notes that with respect to the presumptions found at 38 C.F.R. §§ 3.307, 3.309(a), there is no evidence in the record of the Veteran having compensable bioccipital hemorrhage, or cancer of the head and neck, within one year of service separation. Accordingly, entitlement to presumptive service connection for the disease process that his Certificate of Death listed as causing or contributing to his death that are listed at 38 C.F.R. § 3.303(a) (i.e., bioccipital hemorrhage and cancer of the head and neck) is not warranted. 38 U.S.C.A. §§ 1110, 1131; 38 C.F.R. §§ 3.303, 3.307, 3.309(a). Adding weight to this conclusion is the length of time between the Veteran's separation from his second period of active duty in 1976 and the first complaints and/or treatment for the disease process that his Certificate of Death listed as causing or contributing to his death. In this regard, the Certificate of Death reported that the bioccipital hemorrhage which caused death appeared just prior to death in 2007 and he only had an 8 to 16 month history of cancer of the head and neck (i.e., since approximately 2005/2006), a 6 plus month history of pulmonary nodule (i.e., since 2007), and a two year history of end stage renal disease (i.e., since 2005). As to the Veteran's cancer of the head and neck, treatment records from Elliot Hospital and Cancer Center dated in 2007 show it being diagnosed as squamous cell carcinoma of the skin with neck metastases with positive lymph nodes. Put another way, the Board finds that the decades long gap between the Veteran's discharge from his second period of active duty and the first evidence of any of the claimed disorders that caused or contributed to cause his death weighs heavily against the appellant's claim. See Maxson v. West, 12 Vet. App. 453 (1999), aff'd., 230 F.3d 1330 (Fed. Cir. 2000). In this regard, the Board acknowledges, as it did above, that the widow and her daughter-in-law are competent to give evidence about what they saw. However, at the personal hearing the widow testified that the medical problems that eventually caused the Veteran's death started in approximately 1997- over twenty years after his separation from his second period of active duty in 1976. Moreover, the Board finds that any claims regarding continuity of symptoms since service are contrary to what is found in the service and reserve component medical records including the October 1972 separation examination and the November 1979, November 1983, and May 1988 reserve component examinations which were uniform in reporting normal clinical evaluations. Additionally, while the May 1988 reserve component examination reported a history of tumor, cyst, or growth, it thereafter explained that this was reference to a cyst that was removed in April 1988. Likewise, the post-service medical records are negative for two decades after the Veteran's separation from his second period of active duty for complaints, diagnoses, or treatment for any of his disease process that the Certificate of Death listed as causing or contributing to Veteran's death (i.e., bioccipital hemorrhage, cancer of the head and neck, pulmonary nodule, and end stage renal disease). In these circumstances, the Board gives more credence and weight to the medical evidence of record, which is negative for complaints, diagnoses, or treatment for any of the claimed disorders for two decades following the Veteran's second period of active duty, than any claims by the widow and others to the contrary. See Owens v. Brown, 7 Vet. App. 429, 433 (1995) (holding that VA may favor the opinion of one competent medical expert over that of another when decision makers give an adequate statement of reasons and bases). Thus, this is additional evidence that the disease processes that the Certificate of Death listed as causing or contributing to the Veteran's death are not related to service. In evaluating the evidence, the Board also notes that some of the Veteran's post-service medical records include medical opinions linking at least one of the disease processes that his Certificate of Death listed as causing or contributing to his death (i.e., end stage renal disease) to his alleged exposure to Agent Orange while in military service. See Pinnacle Health record dated in January 2006 (end stage renal disease secondary to IgA nephropathy presumably caused by Agent Orange); Elliot Hospital and Cancer Center discharge summary dated in May 2007 (end-stage renal disease with chronic renal failure secondary to Agent Orange); and Hazelton General Hospital treatment records dated in May 2006 (end-stage renal disease probably secondary to Agent Orange exposure) and December 2006 (end-stage renal disease probably secondary to Agent Orange exposure versus hypertension). The Board, however, it is not required to accept evidence that is simply information recorded by a medical examiner unenhanced by medical opinion. LeShore v. Brown, 8 Vet. App. 406 (1995); Godfrey v. Brown, 8 Vet. App. 113, 121 (1995). The Board considers these to be nothing more. Therefore, the opinions by the healthcare providers that at least one of the disease process that the Veteran's Certificate of Death listed as causing or contributing to his death (i.e., end stage renal disease) was caused by his in-service exposure to Agent Orange, are considered to be based on an inaccurate factual premise (i.e., the claimant's in-service exposure to Agent Orange when, as explained above, there is no proof of such exposure). As such, these opinions are not probative evidence. See Reonal v. Brown, 5 Vet. App. 458, 461 (1993); Also see Madden v. Gober, 125 F.3d. 1477 1481 (Fed. Cir. 1997) (holing that the Board is entitled to discount the credibility of evidence in light of its own inherent characteristics and its relationship to other items of evidence). As to any assertion by the widow and/or her daughter-in-law that the disease process that the Veteran's Certificate of Death listed as causing or contributing to his death (i.e., bioccipital hemorrhage, cancer of the head and neck, pulmonary nodule, and end stage renal disease) were caused by the Veteran's military service, they are not competent to offer such an opinion. These conditions are complex medical illnesses, about which a lay person is not competent to validly opine as to their cause. Therefore, this evidence does not serve to establish service connection for purposes of this appeal. The appellant has also submitted a medical article dated in March 2011. In this regard, medical article and treatise evidence that discusses relationships with certainty may be used to meet the requirement for a medical nexus. Wallin v. West, 11 Vet. App. 509 (1998). Additionally, medical treatise evidence can provide important support when combined with an opinion of a medical professional. Mattern v. West, 12 Vet. App. 222, 228 (1999). See Rucker v. Brown, 10 Vet. App. 67, 73-74 (1997) (holding that evidence from scientific journal combined with doctor's statements was "adequate to meet the threshold test of plausibility"). However, an attempt to establish a medical nexus between service and a disease or injury solely by generic information in a medical journal or treatise "is too general and inclusive." Sacks v. West, 11 Vet. App. 314, 317 (1998) (a medical article that contained a generic statement regarding a possible link between a service-incurred mouth blister and a present pemphigus vulgaris condition did not satisfy the nexus element). The Board finds that the medical article submitted by the appellant only reflects generic information regarding exposure to herbicides in the Republic of Vietnam and later developing certain types of cancers. The Board also notes that it is not supported by any definitive or concrete medical opinion. Moreover, having concluded the Veteran did not serve in Vietnam, information such as this is not pertinent. Lastly, the Board notes that the disease process that the Veteran's Certificate of Death listed as causing or contributing to his death are disease, and not injuries. Therefore, the Board finds that service connection cannot be granted due to any INACDUTRA service. 38 U.S.C.A. §§ 101(24), 106, 1110. The record is negative for a competent and credible opinion expressing a causal association or link between any of the diseases that the Veteran's Certificate of Death listed as causing or contributing to his death (i.e., bioccipital hemorrhage, cancer of the head and neck, pulmonary nodule, and end stage renal disease) and an established injury, disease, or event on active duty or ACDUTRA service or injury during any INACDUTRA service. See 38 U.S.C.A. §§ 1110, 1131; 38 C.F.R. § 3.303(d); Rabideau, supra. Entitlement to service connection is not established. Having decided that the record does not show that the Veteran should have been service connected for a disability during his lifetime that caused or contributed substantially to cause his death, service connection for the cause of the Veteran's death must be denied. See 38 U.S.C.A. § 1310; 38 C.F.R. § 3.312. In reaching the above conclusion, the Board also considered the doctrine of reasonable doubt. 38 U.S.C.A. § 5107(b). However, as the preponderance of the evidence is against the claim, the doctrine is not for application. See also, e.g., Ortiz v. Principi, 274 F. 3d 1361 (Fed. Cir. 2001); Gilbert v. Derwinski, 1 Vet. App. 49 (1990). The Accrued Benefits Claim Among the requirements for accrued benefits, is that the Veteran have a claim pending for VA benefits at the time of his death. See 38 U.S.C.A. §§ 5101(a), 5121(a); Jones v. West, 136 F.3d 1299 (Fed. Cir. 1998). However, at the time of the Veteran's death in October 2007 the record does not show, and the appellant does not claim, that he had a claim pending for VA benefits. In fact, in her August 2008 VA Form 21-534, Application for Dependency and Indemnity Compensation, Death Pension and Accrued Benefits by a Surviving Spouse or Child (Application), the widow checked the box saying that the Veteran had not ever filed a claim with VA. Therefore, as the pertinent facts as to this claim are not in dispute, the Board finds that the law is dispositive. Because the Veteran did not have a claim for VA benefits pending at the time of his death, the claim for accrued benefits lacks legal merit. ORDER Entitlement to service connection for the cause of the Veteran's death is denied. Entitlement to basic eligibility for accrued benefits is denied. ______________________________________________ MICHAEL E. KILCOYNE Veterans Law Judge, Board of Veterans' Appeals Department of Veterans Affairs