Citation Nr: 1318494 Decision Date: 06/06/13 Archive Date: 06/11/13 DOCKET NO. 05-40 683 ) DATE ) ) On appeal from the Department of Veterans Affairs (VA) Regional Office (RO) in San Diego, California THE ISSUES 1. Entitlement to service connection for peripheral neuropathy in the upper extremities. 2. Entitlement to service connection for peripheral neuropathy in the lower extremities. 3. Entitlement to service connection for a foot disability manifested by recurrent infections, to include osteomyelitis. 4. Entitlement to service connection for a disability manifested by hair loss, to include male pattern baldness and alopecia. 5. Entitlement to service connection for a disability of the kidneys, to include cancer. REPRESENTATION Appellant (the Veteran) is represented by: Disabled American Veterans WITNESSES AT HEARING ON APPEAL The Veteran and his spouse ATTORNEY FOR THE BOARD L. Cramp, Counsel INTRODUCTION The Veteran had active service from February 1955 to January 1957. This appeal comes before the Board of Veterans' Appeals (Board) from a June 2004 rating decision of the RO in San Diego, California. The Veteran and his wife attended a Board hearing at the RO in August 2007. Subsequently, the individual who conducted that hearing was designated Acting Chairman of the Board of Veterans Appeals and is no longer available to decide the appeal. In January 2013, the Veteran was notified that he could attend another hearing conducted by the Veterans Law Judge who would decide his appeal. See 38 U.S.C.A. § 7107(c) (West 2002 & Supp. 2012); 38 C.F.R. § 20.707 (2012) (requiring that the Veterans Law Judge who conducts a hearing on an appealed issue must participate in any decision made on that appeal). The Veteran was notified that if he did not respond within 30 days, the Board would assume that he did not want another hearing. To date, the Veteran has not responded to the January 2013 letter, and the time limit has expired. In August 2009, the Board remanded these issues for additional evidentiary development. At that time, the Board also denied service connection for skin cancer and hand tremors. In August 2011, the Board again remanded the above issues for additional evidentiary development. The Board also granted service connection for cervical degenerative osteoarthritis, an issue on appeal at that time. The Board's decision with respect to the previously adjudicated claims is final. See 38 C.F.R. § 20.1100 (2012). In reviewing this case the Board has not only reviewed the Veteran's physical claims file, but also his file on the "Virtual VA" system to insure a total review of the evidence. 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. All notification and development action needed to fairly adjudicate the appeal has been accomplished. 2. The Veteran had no service in the Republic of Vietnam, and was not exposed to herbicide agents during service; the Veteran has chronic peripheral neuropathy, but does not have acute or subacute peripheral neuropathy. 3. The Veteran was not exposed to ionizing radiation in service. 4. Peripheral neuropathy, a foot disability manifested by recurrent infections, to include osteomyelitis, a disability manifested by hair loss, to include male pattern baldness and alopecia, and a disability of the kidneys, to include cancer, are not listed among the diseases for which the presumption of service connection for certain chronic diseases, and the provisions regarding chronicity in service and continuity of symptomatology after service must be considered. 5. Symptoms of peripheral neuropathy, a foot disability manifested by recurrent infections, to include osteomyelitis, a disability manifested by hair loss, to include male pattern baldness and alopecia, and a disability of the kidneys, to include cancer, were not chronic in service. 6. The Veteran's current peripheral neuropathy, foot disability manifested by recurrent infections, to include osteomyelitis, disability manifested by hair loss, to include male pattern baldness and alopecia, and a disability of the kidneys, to include cancer, are not related to service. CONCLUSIONS OF LAW 1. Peripheral neuropathy of the upper extremities was not incurred in service. 38 U.S.C.A. §§ 1131, 5103, 5103A, 5107, 7104 (West 2002); 38 C.F.R. §§ 3.102, 3.159, 3.303 (2012). 2. Peripheral neuropathy of the lower extremities was not incurred in service. 38 U.S.C.A. §§ 1131, 5103, 5103A, 5107, 7104 (West 2002); 38 C.F.R. §§ 3.102, 3.159, 3.303 (2012). 3. A disability manifested by recurrent foot infections, to include osteomyelitis, was not incurred in service. 38 U.S.C.A. §§ 1131, 5103, 5103A, 5107, 7104 (West 2002); 38 C.F.R. §§ 3.102, 3.159, 3.303 (2012). 4. A disability manifested by hair loss, to include male pattern baldness and alopecia, was not incurred in service. 38 U.S.C.A. §§ 1131, 5103, 5103A, 5107, 7104 (West 2002); 38 C.F.R. §§ 3.102, 3.159, 3.303 (2012). 5. A disability of the kidneys, to include cancer was not incurred in service. 38 U.S.C.A. §§ 1131, 5103, 5103A, 5107, 7104 (West 2002); 38 C.F.R. §§ 3.102, 3.159, 3.303 (2012). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS Service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by active military, naval, or air 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). The CAVC has held that "Congress specifically limits entitlement for service-connected disease or injury to cases where such incidents have resulted in a disability. In the absence of proof of a present disability there can be no valid claim." Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992); see also Rabideau v. Derwinski, 2 Vet. App. 141, 143-44 (1992). Certain specific conditions are considered chronic diseases under VA Law. These include the following: Anemia, primary; Arteriosclerosis; Arthritis; Atrophy, progressive muscular; Brain hemorrhage; Brain thrombosis; Bronchiectasis; Calculi of the kidney, bladder, or gallbladder; Cardiovascular-renal disease, including hypertension. (This term applies to combination involvement of the type of arteriosclerosis, nephritis, and organic heart disease, and since hypertension is an early symptom long preceding the development of those diseases in their more obvious forms, a disabling hypertension within the 1-year period will be given the same benefit of service connection as any of the chronic diseases listed); Cirrhosis of the liver; Coccidioidomycosis; Diabetes mellitus; Encephalitis lethargica residuals; Endocarditis. (This term covers all forms of valvular heart disease); Endocrinopathies; Epilepsies; Hansen's disease; Hodgkin's disease; Leukemia; Lupus erythematosus, systemic; Myasthenia gravis; Myelitis; Myocarditis; Nephritis; Other organic diseases of the nervous system; Osteitis deformans (Paget's disease); Osteomalacia; Palsy, bulbar; Paralysis agitans; Psychoses; Purpura idiopathic, hemorrhagic; Raynaud's disease; Sarcoidosis; Scleroderma; Sclerosis, amyotrophic lateral; Sclerosis, multiple; Syringomyelia; Thromboangiitis obliterans (Buerger's disease); Tuberculosis, active; Tumors, malignant, or of the brain or spinal cord or peripheral nerves; Ulcers, peptic (gastric or duodenal)(A proper diagnosis of gastric or duodenal ulcer (peptic ulcer) is to be considered established if it represents a medically sound interpretation of sufficient clinical findings warranting such diagnosis and provides an adequate basis for a differential diagnosis from other conditions with like symptomatology; in short, where the preponderance of evidence indicates gastric or duodenal ulcer (peptic ulcer). Whenever possible, of course, laboratory findings should be used in corroboration of the clinical data. 38 C.F.R. § 3.309(a). Where one of the above chronic diseases is shown to be chronic in service (or within the presumptive period under § 3.307) so as to permit a finding of service connection, subsequent manifestations of the same chronic disease at any later date, however remote, are service connected, unless clearly attributable to intercurrent causes. 38 C.F.R. § 3.303(b). For the showing of chronic disease in service there is required a combination of manifestations sufficient to identify the disease entity, and sufficient observation to establish chronicity at the time, as distinguished from merely isolated findings or a diagnosis including the word "Chronic." When the disease identity is established (leprosy, tuberculosis, multiple sclerosis, etc.), there is no requirement of evidentiary showing of continuity. 38 C.F.R. § 3.303(b). Continuity of symptomatology is required only where the condition noted during service (or in the presumptive period) is not, in fact, shown to be chronic or where the diagnosis of chronicity may be legitimately questioned. When the fact of chronicity in service is not adequately supported, then a showing of continuity after discharge is required to support the claim. 38 C.F.R. § 3.303(b). Where a veteran served 90 days or more during a period of war or after December 31, 1946, and any of the chronic diseases listed above becomes manifest to a degree of 10 percent within 1 year from date of termination of such service (for Hansen's disease (leprosy) and tuberculosis, within 3 years; multiple sclerosis, within 7 years), such disease shall be presumed to have been incurred in service, even though there is no evidence of such disease during the period of service. This presumption is rebuttable by affirmative evidence to the contrary. 38 U.S.C.A. §§ 1101, 1112, 1113; 38 C.F.R. §§ 3.307, 3.309. 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. Gabrielson v. Brown, 7 Vet. App. 36, 39-40 (1994); Gilbert v. Derwinski, 1 Vet. App. 49, 57 (1990). Competency of evidence differs from weight and credibility. Competency is a legal concept determining whether testimony may be heard and considered by the trier of fact, while credibility 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"). Lay statements 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. See Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007); Buchanan v. Nicholson, 451 F.3d 1331, 1336(Fed. Cir. 2006) (addressing lay evidence as potentially competent to support presence of disability even where not corroborated by contemporaneous medical evidence). The CAVC has emphasized that when a condition may be diagnosed by its unique and readily identifiable features, the presence of the disorder is not a determination "medical in nature" and is capable of lay observation. In such cases, the Board is within its province to weigh that testimony and to make a credibility determination as to whether that evidence supports a finding of service incurrence and continuity of symptomatology sufficient to establish service connection. See Barr v. Nicholson, 21 Vet. App. 303(2007); Davidson v. Shinseki, 581 F.3d 1313(Fed. Cir. Sept. 14, 2009). The Veteran asserts that each of the claimed disorders is associated with exposure to Agent Orange, commercial herbicides, insecticides, lead paint, and/or various unidentified chemicals during service. In addition, he has asserted that his kidney cancer resulted from radiation exposure during service. Regarding herbicides, applicable law provides that a veteran who, during active military, naval, or air service, served in the Republic of Vietnam during the period beginning on January 9, 1962, and ending on May 7, 1975, shall be presumed to have been exposed during such service to an herbicide agent, unless there is affirmative evidence to establish that the veteran was not exposed to any such agent during that service. 38 C.F.R. § 3.307(a)(6)(iii). In this case, the Veteran does not contend that he served in Vietnam, or that the alleged exposure to herbicides occurred in Vietnam. The Veteran has alleged that he was exposed to herbicides in Yokosuka, Japan. While the Department of Defense has confirmed the operational use, testing, and disposal of Agent Orange and other herbicides outside of Vietnam, such exposure is not presumed for any veteran. Notwithstanding the lack of any presumption of exposure to herbicides, the Board finds that the Veteran was not actually exposed during service to any herbicide agent as set under the presumptive provisions. There is no record of actual exposure to Agent Orange or other tactical herbicides. As discussed in the Board's discussion of VCAA compliance below, the RO requested records from the NPRC, JSRRC, and NMCPHC regarding actual exposure to herbicides in Yokosuka, and received negative replies from all agencies. The Veteran may be competent in some circumstances to report such exposure, where there are reliable indicators of the type of agent used and reliable indicators of actual contact with the agent. The Board has accordingly considered the Veteran's assertions regarding actual exposure. In March 2004 correspondence, the Veteran reported that, on one occasion, while jogging around an athletic field, he noticed someone spraying some type of herbicide to control weeds in different areas. He reported that, "[t]he smell was very strong and it started to make me sick, at which time I had to stop jogging." The next day, he reportedly went to sick bay complaining about shortness of breath and feeling nauseated. He was told they could not find anything seriously wrong and that he would feel better in a few days. In a September 2007 VA outpatient primary care note, the Veteran elaborated on his account of having been exposed to herbicides while jogging. According to the examiner, the Veteran related a "long story" of being exposed to some type of spray while he was running in a field to train for football. The Veteran asserted that his records show that he was treated for "asthma" after running on the track, and that this treatment demonstrates that he was exposed to something. The Veteran is certainly competent to describe what he observed, as well as his reaction to these events. However, the service treatment records reveal a substantially different details of his treatment for asthma symptoms than is reflected in his recent account, and these differences undermine the credibility of his recent account. Service treatment records reveal that the Veteran was treated in June 1955 for complaints of chest tightness (frequently at night) and a productive cough, as well as a weight loss of 13 pounds in 2 months. The Veteran reported that the rainy season caused increased symptoms. Although the examiner diagnosed asthma, he acknowledged that he observed no wheezing, and in fact found that the Veteran showed no evidence of asthma or asthmatic bronchitis. The initial diagnosis was asthma, perennial, allergen unknown. The same examiner saw the Veteran again in July 1955. The examiner noted that, just as before, he had not heard any wheezes. The Veteran's blood count and chest X-ray were normal. A discussion with the Veteran revealed that he had hyperventilation syndrome. The Veteran also reported family-related issues that were occurring at the time. The examiner then noted that the Veteran was admitted on this occasion because he had reported a temperature of 100; however, the temperature had promptly subsided before he arrived. The examiner concluded that the Veteran did not have asthma at all, but had a psychogenic respiratory reaction. Thus, the contemporaneous account of the Veteran's treatment for asthma symptoms in service makes no reference to any recent exposure to spraying at an athletic facility. Rather, the Veteran referred to a seasonal component to his symptoms, which he related to the rainy season. More significant, the examiner concluded that the Veteran did not actually have asthma, but that the Veteran's symptoms were manifestations of a psychogenic reaction. The Board finds that, if the Veteran's recent assertion is true, i.e., that the Veteran had recently been exposed to the spraying of herbicides or other chemicals, to which he experienced a visceral reaction, it is reasonable to expect that these details would have been reported to the examiner. The Veteran's recent account does not describe a casual exposure, but asserts that he had a strong physical reaction at the time, started to get sick, and had to stop jogging. The Veteran testified at the hearing that the spray burned his eyes and lungs, and he went back to base and lay down. These are the type of details that are reasonable to expect an individual seeking medical treatment to report. The Veteran did not report such details, and did not mention inhaling any type of spray. Rather, he discussed seasonal flare-ups of symptoms during the rainy season, as well as family-related issues. The in-service treatment record is inconsistent with his recent account. The Board also notes that, while the Veteran has asserted that the spray contained an herbicide, his testimony at the hearing was that he did not know the contents of the spray. However, later in the hearing, the Veteran testified that he was sure the spray was an herbicide. He then identified the alleged herbicide as DDT. The Board observes that DDT is an insecticide, not an herbicide. Notwithstanding the Veteran's ultimate uncertainty as to what he was exposed to, based on the inconsistencies in the Veteran's recent account, as compared to the account he gave at the time of the alleged exposure, the Board finds that the Veteran's recent account of having been exposed to herbicides or other chemicals while jogging in service is false. In March 2004 correspondence, the Veteran reported that, while stationed in Yokosuka Japan, he worked out of a large cave, which had different types of munitions and several 55-gallon drums. He reported, "I was never told what the drums contained." A slightly different account emerged from the August 2007 hearing testimony. The Veteran reiterated that "I don't know what was in the barrels; I never asked and I don't know what they were even used for." However, after stating emphatically that he did not know what was in the barrels, he then offered that "I think that was what they used to spray the weeds with." When asked specifically whether he knew this to be the case, and he answered, "[i]t could have been. Like I said, I don't know." The Veteran testified that some of the contents of the drums was spilled out around the bottoms and he might have walked through it. When asked if he actually remembered walking through it, he answered, "[y]es." In a September 2007 VA outpatient report, the Veteran varied the details of this account, stating that a drum was tipped over with its contents spilling and he was exposed to it. He reiterated that he does not know what the contents were. With respect to either account, the Veteran does not contend that he was exposed to herbicides or to any specific chemical. His account is that he does not know what was in the drums. To the extent the Veteran now asserts that the contents of these drums may have contributed to any of his claimed disabilities, this amounts to speculation and is not credible evidence. Simply stated, based on a review of the of Veteran's statements as a whole, the Veteran is not always an accurate historian of events from nearly fifty years ago. In sum, the Board finds that the Veteran was not exposed to any herbicide agent, including Agent Orange/herbicide during service. In addition, the Board notes that the Veteran does not have an Agent Orange presumptive disease. While the Veteran has been diagnosed with peripheral neuropathy, neuropathy related to herbicide exposure is limited to acute and subacute transient peripheral neuropathy. As specified in the regulations, this must appear within 1 year of exposure and resolve within 2 years of date of onset. The Veteran asserts that his feet began to hurt in 1961. This is more than 1 year after service separation. Moreover, the Veteran still carries a diagnosis of peripheral neuropathy. Therefore, it did not resolve within 2 years of onset. Moreover, an April 2010 VA examiner specifically found that the Veteran did not have acute or subacute peripheral neuropathy. Therefore, even if it could be shown that the Veteran had been exposed to Agent Orange or other herbicide agents in service, the lack of an Agent Orange presumptive disease renders the presumption of service connection inapplicable. The Board also acknowledges the Veteran's March 2004 assertion that, while in the reserves, in the summer of 1954, he was exposed to lead paint and red oxide primer while chipping, priming, and painting. The Veteran's service records indicate that he was enrolled in the U.S. Naval Reserve in 1954, and there is no indication that he had any period of active duty service other than from February 1955 to January 1957. While the Veteran appears to assert that he was performing either active duty for training (ADT) or inactive duty training (IDT), that alone would not suffice to establish his status as a veteran for this period of service. Generally, in order to qualify for VA benefits, a claimant must be a veteran. See Dingess v. Nicholson, 19 Vet. App. 473, 484 (2006) (status as a "veteran" is one of the five elements of a claim for service-connection benefits). One of the benefits administered by VA that is reserved specifically for veterans is disability compensation. Accordingly, in order to establish his entitlement to disability compensation benefits, he or she must first establish "veteran" status. The term "veteran" is defined in 38 U.S.C.A. § 101(2) as "a person who served in the active military, naval, or air service, and who was discharged or released therefrom under conditions other than dishonorable." The term "active military, naval, or air service" includes active duty, and "any period of active duty for training (ADT) during which the individual concerned was disabled or died from a disease or injury incurred or aggravated in line of duty, and any period of inactive duty training (IDT) during which the individual concerned was disabled or died from an injury incurred or aggravated in line of duty." 38 U.S.C.A. § 101(24); 38 C.F.R. § 3.6(a); see Biggins v. Derwinski, 1 Vet. App. 474, 477-478 (1991). ADT is defined, in part, as "full-time duty in the Armed Forces performed by reserves for training purposes." 38 U.S.C.A. § 101(22); 38 C.F.R. § 3.6(c). The term IDT is defined, in part, as duty, other than full- time duty, under sections 316, 502, 503, 504, or 505 of title 32 [U. S. Code] or the prior corresponding provisions of law. 38 U.S.C.A. § 101(23); 38 C.F.R. § 3.6(d). While service on active duty alone is sufficient to meet the statutory definition of veteran, service on ADT (or IDT), without more, will not suffice to give one "veteran" status. Donnellan v. Shinseki, 24 Vet. App. 167, 172 (2010). Before veteran status can be established for the period of reserve service, it must first be established that the appellant was disabled from a disease or injury incurred or aggravated in line of duty during ADT, or that he was disabled from an injury incurred or aggravated in line of duty during IDT. The Board finds that the weight of the evidence demonstrates that the Veteran did not become disabled due to disease or injury incurred in the line of duty during any period of ADT or IDT; therefore, veteran status does not attach to this period. In so finding, the Board notes that service connection is only in effect for a cervical spine disability incurred as a result of an accident during the Veteran's period of active duty service. Indeed, the Veteran has not described becoming disabled due to any injury or disease during ADT or IDT, only that he was exposed to lead paint during this period and had onset of disabilities years later. The Board also notes that the Veteran has asserted that his kidney cancer is related to radiation exposure. However, he has never described when, where, or how he was exposed to radiation. Instead, he simply has referred to a letter sent to him following a October 2004 VA ionizing radiation examination. That letter informs him that renal cell carcinoma is included among the diseases presumptively associated with radiation exposure under VA law. However, it also notifies him that, if he is seeking service connection, he must file a claim demonstrating that the disease was incurred in service. Neither the October 2004 letter nor the October 2004 VA ionizing radiation examination establish or even suggest that the Veteran was ever exposed to ionizing radiation. The Veteran has not submitted, identified, or even alluded to such evidence. Although service connection is not presumed, and herbicide exposure is not presumed or otherwise shown by the record, service connection can also be established by showing that the claimed disabilities were incurred during or aggravated by service, a task which includes the difficult burden of tracing causation to a condition or event during service. See Combee v. Brown, 34 F.3d 1039, 1043 (Fed. Cir. 1994). After a review of all of the evidence, the Board finds that the weight of the evidence demonstrates that symptoms of peripheral neuropathy, a foot disability manifested by recurrent infections, to include osteomyelitis, a disability manifested by hair loss, to include male pattern baldness and alopecia, and a disability of the kidneys, to include cancer, were not chronic in service and the Veteran's current peripheral neuropathy, foot disability manifested by recurrent infections, osteomyelitis, disability manifested by hair loss, to include male pattern baldness and alopecia, and disability of the kidneys, to include cancer, are not related to service. Service treatment records reveal no treatment for peripheral neuropathy, foot infections, osteomyelitis, hair loss, alopecia, or kidney disability. The Veteran was examined at discharge from active duty in January 1957 and was found to be clinically normal regarding the upper extremities, lower extremities, feet, head, and genitourinary system. The Board notes that peripheral neuropathy, a foot disability manifested by recurrent infections, to include osteomyelitis, a disability manifested by hair loss, to include male pattern baldness and alopecia, and a disability of the kidneys, to include cancer, are not listed under 38 C.F.R. § 3.309(a), therefore 38 C.F.R. § 3.309(b) does not apply. See Walker, supra. 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). The Board finds that the current peripheral neuropathy, foot disability manifested by recurrent infections, to include osteomyelitis, disability manifested by hair loss, to include male pattern baldness and alopecia, and disability of the kidneys, to include cancer, are not related to service. In so finding, the Board notes that a September 2007 report from W.W.C., M.D. reveals that the Veteran has always been diagnosed with idiopathic peripheral neuropathy, indicating that the cause was unknown. W.W.C. noted that the Veteran claims his peripheral neuropathy is due to exposure to toxic substances such as ionizing radiation, but also claimed that he had been exposed to Agent Orange while he was in the service. W.W.C. noted that he had no way of confirming his exposure to toxic substances during his military duty; however, there is a distinct possibility that if he was exposed to toxic substances such as Agent Orange or ionizing radiation for long periods of time that it may have caused his peripheral neuropathy as we have not found a cause of it such as toxic medications for diabetic polyneuropathy. W.W.C. then concluded, "I suppose it is possible that this is caused by toxic substances, that is the polyneuropathy and the subsequent osteomyelitis in his feet as all this is not common with non-diabetic patients." The Board attaches no probative weight to W.W.C.'s opinion for two reasons: It is ultimately inconclusive, stating that a relationship is "possible" (the Board would never suggest that the Veteran's contentions are "impossible", therefore, the contention that it is "possible" says almost nothing). The question is whether the Veteran's disabilities are at least as likely as not (50% or greater chance) related to service, not whether it is possible. The CAVC has repeatedly and consistently rejected medical opinions raising only a possibility of medical nexus as being insufficient to establish nexus. See McLendon v. Nicholson, 20 Vet. App. 79, 85 (2000); Beausoleil v. Brown, 8 Vet. App. 459 (1996) (general and inconclusive statement about the possibility of a link between current disability and service injury is insufficient); Tirpak v. Derwinski, 2 Vet. App. 609, 611 (1992). In essence, a medical opinion that is not conclusively stated, but asserts only the possibility of a relationship, is not probative evidence, or evidence that tends to prove the question at hand. In addition, the opinion of W.W.C. is explicitly conditioned on the veracity of the Veteran's account of exposure to Agent Orange or radiation. As discussed above, the Board has found no such exposure. The Veteran's own statements at some point provide evidence against this current contentions and are, at some point, very unclear. Another private clinician, L.L.C., D.P.M. provided an opinion in October 2007 regarding the Veteran's foot disability. He noted that peripheral neuropathy contributed significantly to the foot condition both in cause and healed outcome. He has non-diabetic peripheral neuropathy that is at least as likely as not (50/50 probability) caused by or the result of exposure to chemicals, metals or ionizing radiation. L.L.C. then went on to qualify his opinion in inconclusive language, stating that it was his opinion that the Veteran "could have" been exposed to such material during his military service that "could have" resulted in peripheral neuropathy that lead to his disabled condition. Even if we could sever the ultimately inconclusive portion of the opinion and consider only the initial statement, this does not provide a link to an actual confirmed in-service event. L.L.C.'s description of chemicals, metals, or ionizing radiation is exceedingly vague. Not only is no reasoning provided, L.L.C.'s lack of specificity as to the causative agent renders any rationale impossible. In other words, while L.L.C's opinion is partially phrased in conclusive terminology, his imprecision in defining the relationship renders the opinion ultimately inconclusive and of no probative weight. The Board also notes that it has previously found that the Veteran was not exposed to radiation. While the reference to chemicals could be read to apply to insecticide, the Board declines to make such a leap, as L.L.C. never mentioned insecticide. The probative value of medical evidence is based on the physician's knowledge and skill in analyzing the data, and the medical conclusion the physician reaches; as is true of any evidence, the credibility and weight to be attached to medical opinions are within the province of the Board. See Guerrieri v. Brown, 4 Vet. App. 467, 470-471 (1993). Based on the imprecision and inconclusive nature of L.L.C.'s opinion, and his lack of any rationale, the Board finds that it is of no probative value. Simply stated, if the Veteran was not exposed to problems cited (radiation and herbicides), as has been found, the weight of the medical opinions lose probative value. An October 2007 opinion by E.Y.W., M.D. notes that the Veteran claimed that his peripheral neuropathy was related to the exposure to toxic substances and to Agent Orange while he was in service in Asia. E.Y.W. cautioned, "[t]hough I am not a neurologist, and ha[ve] no confirmation, based on his history, in my opinion, his peripheral neuropathy could be at least as likely as not caused by exposure to substances and to Agent Orange he was exposed in service." Foot ulcers and osteomyelitis were most likely related to peripheral neuropathy. As with the opinions of W.W.C and L.L.C, the opinion of E.Y.W. is inconclusive as to nexus based on her use of "could be." In essence, she has provided no assessment of the actual likelihood of the purported etiology. Stating the mere possibility of an etiology does not meet the evidentiary standard necessary for service connection. To the extent that E.Y.W. purports to relate any current disability to Agent Orange exposure, the Board has found that there was no exposure. In addition, E.Y.W. purports to relate specific diagnoses to exposure to "substances." The use of such a vague term leaves the impression that she has no idea what might have been the cause. This underscores the Board's finding that her opinion is inconclusive. The Board also notes that E.Y.W. provided no rationale. Indeed, logic dictates that there can be no rationale for an opinion purporting to relate a specific diagnosis, such as peripheral neuropathy, to exposure to an unidentified "substance." A September 2007 opinion from a VA clinician notes the Veteran's account of a history of being exposed to chemicals during his service, and that, shortly afterwards, he started to have loss of hair and tingling in his feet which has slowly progressed to the state he is now finding himself in. The clinician opined that according to his history, this is as likely as not caused by the potential exposure to chemicals during his service. As with the opinions of L.L.C. and most notably, E.Y.W. the VA clinician's opinion does not identify a specific cause. While the VA clinician at least narrows the field to chemicals, given the Veteran's varying accounts of chemical exposure, including Agent Orange, commercial herbicides, insecticides, and drums full of unknown chemicals, all but one of which (insecticide) the Board has found to be false, such imprecision conveys the distinct message of uncertainty. As noted above, there is no opinion that purports to relate any disability to purported exposure to insecticide sprayed around the Veteran's barracks, and none of the opinions above are specific enough to make that connection. Turning to the matter of insecticide exposure, in addition to the Veteran's accounts of herbicide, radiation, and other chemical exposure in service, in March 2004 correspondence, the Veteran reported that, several times during summer months, they would use a Jeep equipped with a large fog sprayer and would spray insecticide all around the base. In a September 2007 VA outpatient record, the Veteran asserted that he was exposed to DDT spraying while in the barracks. The Board finds that there is nothing inherently incredible about the assertion that the Veteran was exposed to insecticides in the normal course of his service. In contrast to the other accounts, there is no contradictory evidence in the record that undermines this account. The Board at this point must unfortunately note that the Veteran's statements and history are not consistent and he appears, overall, to be providing a history to examiners that will somehow associate his current disabilities with service nearly fifty years ago. In this regard, the Board must find that the Veteran is not an accurate historian. However, even assuming that the Veteran was exposed to an insecticide, there is no medical opinion of record that specifically and conclusively relates any of the claimed disabilities to this exposure. The Board has already discussed many details of the September 2007 report of a VA osteopath regarding the Veteran's assertions as to exposure to radiation, insecticide, herbicide, and a drum full of unknown chemicals. That report contains the osteopath's notation that he could not say that the neuropathy and other problems were caused directly by any particular exposure in the service; however, he opined that the history does suggest that the symptoms "may have" started in the service. Based on his history there is a possibility that his problems are service related. As discussed at length above, an inconclusive opinion carries no probative weight, and the September 2007 opinion is manifestly inconclusive. For reasons already stated at length, the Board attaches no probative weight to opinions relating specific disabilities to non-specific exposures, such as "chemicals" or "substances." The imprecision of these opinions excludes the possibility of any meaningful rationale for causation. Such opinions are therefore deemed to be speculative and inconclusive. In other words, they are not credible evidence. In addition, the Board finds the lack of complaint or treatment in the service treatment records and the normal clinical findings at service separation to be more persuasive than the Veteran's recent suggestion that symptoms actually began in service. The Veteran has elsewhere specified post-service onset of symptoms. There is no medical opinion that is based on an accurate factual background that conclusively relates any of the claimed disabilities to service. While there are numerous opinions of record that are nominally positive, each is ultimately speculative and/or inconclusive. In some cases this is due to specific language that conveys uncertainty, and in other cases this is due to the imprecise identification of the purported causal agent, or to inaccurate identification, i.e., the Board has found that there was no such exposure. While an inconclusive opinion is not sufficient to support a grant of service connection, it may be a sufficient basis for VA to obtain a medical opinion. Here, the Board obtained etiology opinions in April 2010 as to each claimed disability. The Veteran reported that he started to experience pain in both feet in 1961/1962. The symptoms gradually increased to being diagnosed with polyneuropathy and development of the first foot infection in the 1980's. Currently, he experiences severe pain in hands and feet, alopecia, and frequent foot infections. The Veteran reported that he started to lose hair on his head soon after separating from military service (1-2 years later). He progressively began to lose hair on different parts of his body - namely chest, arms, and legs - in around 1995. Currently hair in these areas is sparse. The Veteran reported that he developed an infection in his right foot in the 1980's. He has had numerous foot infections in both in feet since that time. He has had a partial amputation of his right foot from skin and bone infection. He currently has an infection in his right foot that is casted at this time. Regarding peripheral neuropathy, the April 2010 VA examiner acknowledged that the Veteran's private and VA physicians had opined that, in consideration of the Veteran's subjective history, that it was possible that his reported exposure to toxic chemicals could have caused his peripheral neuropathy. The examiner found that the foot infections were aggravated by peripheral neuropathy of the lower extremities, but opined that it is less likely as not that the Veterans peripheral neuropathy, male pattern baldness, alopecia, and foot infections were caused by or aggravated by military service, to include exposure to toxic chemicals, including herbicides and insecticides. The rationale was that, based on review of literature, there was no specific link between Yokosuka Japan and toxic chemicals including herbicides and insecticides, and the evidence did not support or indicate such exposure. The examiner also distinguished between the type of neuropathy the Veteran had been diagnosed with, noting that only acute and subacute peripheral neuropathy were deemed associated with herbicide exposure. The examiner acknowledged a review of "previous medical opinions" but concluded that a nexus could not be established. It is the Board's responsibility to evaluate the evidence and to assign each report or opinion its due probative weight. Owens v. Brown, 7 Vet. App. 429, 433 (1995). In reviewing the evidence, the Board is free to favor one medical opinion over another if the Board provides an adequate statement of reasons or bases. Id.; see also 38 U.S.C. § 7104(d)(1). In this case, the April 2010 VA opinion is the only opinion accorded any probative weight. While the Board acknowledges that there was little elaboration regarding the rationale, still, a rationale was provided, and that rationale is consistent with the accepted factual background, and is stated conclusively. This distinguishes it from the various opinions purporting to establish a causal relationship. Finally, the Board notes that the Veteran has to some extent related numbness in his hands to his service-connected cervical spine disability. The Board simply notes that service connection for a disability of the cervical spine entails consideration of associated neurological abnormalities in the rating. Thus, there is no additional decision necessary to rate those symptoms, if established by the evidence. However, the matter of the rating for the cervical spine disability is not before the Board on appeal. In summary of the Board's findings, the Veteran was not exposed to herbicide agents during service and does not have an Agent Orange presumptive disease; symptoms of peripheral neuropathy, a foot disability manifested by recurrent infections, to include osteomyelitis, a disability manifested by hair loss, to include male pattern baldness and alopecia, and a disability of the kidneys, to include cancer, were not chronic in service; and, the Veteran's current peripheral neuropathy, foot disability manifested by recurrent infections, to include osteomyelitis, disability manifested by hair loss, to include male pattern baldness and alopecia, and disability of the kidneys, to include cancer, are not related to service. Therefore, service connection for the claimed disabilities is not warranted. In reaching this conclusion, the Board has considered the applicability of the benefit-of-the-doubt doctrine. However, as the preponderance of the evidence is against each claim, that doctrine is not applicable. See 38 U.S.C.A. § 5107(b); 38 C.F.R. § 3.102; Gilbert v. Derwinski, 1 Vet. App. 49, 53-56 (1990). Duties to Notify and Assist The Veterans Claims Assistance Act of 2000 (VCAA) and implementing regulations impose obligations on VA to provide claimants with notice and assistance. 38 U.S.C.A. §§ 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 notice requirements of the VCAA require VA to notify the claimant of what information or evidence is necessary to substantiate the claim; what subset of the necessary information or evidence, if any, the claimant is to provide; and what subset of the necessary information or evidence, if any, VA will attempt to obtain. The Board notes that a "fourth element" of the notice requirement requesting the claimant to provide any evidence in the claimant's possession that pertains to the claim was removed from the language of 38 C.F.R. § 3.159(b)(1). See 73 Fed. Reg. 23,353-356 (April 30, 2008). The United States Court of Appeals for Veterans Claims (CAVC) issued a decision in the appeal of Dingess v. Nicholson, 19 Vet. App. 473 (2006), which held that the 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, including the degree of disability and the effective date of an award. Those five elements include: (1) veteran status; (2) existence of a disability; (3) a connection between a veteran's service and the disability; (4) degree of disability; and (5) effective date of the disability. In this case, written notice provided in January 2004, prior to the appealed June 2004 rating decision, as well as the written notice provided in March 2006 fulfills the provisions of 38 U.S.C.A. § 5103(a) including notice of the type of evidence necessary to establish disability ratings and effective dates for the disabilities on appeal. While the notice of the type of evidence necessary to establish disability ratings and effective dates for the disabilities on appeal was provided after the appeal from the June 2004 rating decision, this timing error is harmless because the claims were subsequently readjudicated. When conducting a hearing, a VA hearing officer - to include a Veterans Law Judge - must suggest that a claimant submit evidence on any issue material to substantiating the claim when the record is missing any evidence on that issue or when the testimony at the hearing raises an issue for which there is no evidence in the record. See Bryant v. Shinseki, 23 Vet. App. 488 (2010); 38 C.F.R. § 3.103 (2012). The hearing officer also must suggest the submission of evidence when testimony during the hearing indicates that it exists (or could be reduced to writing) but is not of record. Here, during the hearing, the Veteran's symptomatology and his account of the events of service were discussed in detail. The importance of obtaining positive nexus opinions was also discussed. The Veteran's Law Judge specifically explained that nexus evidence provides a link between "what you got now and something that happened in service." He further explained that, in order to have weight as evidence, an opinion usually must be by a medical professional, and that such evidence helps strengthen the evidence in your favor. Moreover, the file was left open for 30 days in order to supplement the record. Such actions supplement the VCAA and comply with 38 C.F.R. § 3.103. VA has made reasonable efforts to obtain relevant records and evidence. Specifically, the information and evidence that has been associated with the claims file includes the Veteran's service treatment records, service personnel records, post-service VA treatment records, private treatment records submitted by the Veteran, and the Veteran's written assertions and personal hearing testimony. In addition, the Veteran was afforded VA examinations to address the etiology of the claimed disabilities. These examinations were adequate because each was performed by a medical professional based on acknowledged review of claims file, solicitation of history and symptomatology from the Veteran, and a thorough examination of the Veteran. The resulting opinions were accompanied by rationales that were consistent with the examination findings, and the record. Nieves-Rodriguez v. Peake, 22 Vet. App 295 (2008). The Board also notes that the Veteran has asserted that he has kidney cancer that is related to radiation exposure. Under 38 C.F.R. § 3.311(b), certain "radiogenic diseases" will be service connected provided that certain conditions specified in that regulation are met. These radiogenic diseases include kidney cancer. The regulation states that, if the claimant has one of the radiogenic diseases, a radiation dose assessment will be obtained and the case will be referred to the Under Secretary for Benefits for review as to whether sound scientific medical evidence supports the conclusion that it is at least as likely as not that the disease resulted from radiation exposure during service. In this case, for reasons discussed in greater detail below, the Board finds that no further development for a radiation dose estimate is necessary. First, after examining the Veteran and reviewing the record, an April 2010 VA examiner concluded that the Veteran did not have kidney cancer. While the examiner acknowledged notations of "history of renal carcinoma" in notes of private doctors from Kaiser, he noted that an intravenous urogram with nephrotomography and IVP in October 1984 revealed a horseshoe kidney and renal calculi consisting of calcium oxalate, but no cancer. A November 1988 report shows an episode of urolithiasis, but was otherwise asymptomatic. The Board also notes that October 2002 imaging reveals a horseshoe kidney, but no gross masses, cysts, or renal calculi. In addition to the evidence weighing against a diagnosis of kidney cancer, the Veteran has never described or asserted any specific exposure to radiation. Instead, he simply has referred to a letter sent to him in October 2004 by VA. That letter thanks him for participating in the ionizing radiation registry and informs him that renal cell carcinoma is a disease presumptively associated with radiation exposure under VA law. The Veteran has cited this letter to VA and to his treatment providers as evidence of exposure to radiation in service. However, the letter does not purport to establish such exposure, nor does his participation in the registry. The letter refers to an October 2004 ionizing radiation examination conducted by VA. That examination simply notes a history of treatment for renal cell carcinoma at Kaiser, and notes "need records." Some treatment records from Kaiser have been obtained and were reviewed by the April 2010 examiner; however, the Veteran has not given authorization for VA to request any additional records, if they exist. The examiner found that the available Kaiser records do not show a finding or diagnosis of kidney cancer. The Veteran has provided no other basis for his assertion of radiation exposure other than the VA letter. He has not described any radiation risk activity or any specific activity that he believes may have exposed him to ionizing radiation. The references in the record are entirely circular. Indeed, the Veteran testified " I don't even know what caused my kidney cancer. It was just something that came up on me." Thus, irrespective of the Board's finding that the Veteran has no history of kidney cancer, the Board also finds that the Veteran was not exposed to ionizing radiation during service. Accordingly, the Board finds that there is no basis for additional development under these provisions. See Soyini v. Derwinski, 1 Vet. App. 541 (1991) (strict adherence to requirements in the law does not dictate an unquestioning, blind adherence in the face of overwhelming evidence in support of the result in a particular case; such adherence would result in unnecessarily imposing additional burdens on VA with no benefit flowing to the claimant); Sabonis v. Brown, 6 Vet. App. 426, 430 (1994) (remands which would only result in unnecessarily imposing additional burdens on VA with no benefit flowing to the claimant are to be avoided). More delay of this case, beyond the delays above, are simply not warranted and will not provide a basis to grant any of the remaining claims. Remand Compliance As noted above, this appeal involves a remand by the Board for additional evidentiary development. A remand by the Board confers on the claimant, as a matter of law, the right to compliance with the remand orders. Stegall v. West, 11 Vet. App. 268, 271 (1998). While substantial compliance is required, strict compliance is not. D'Aries v. Peake, 22 Vet. App. 97, 105 (2008) citing Dyment v. West, 13 Vet. App. 141, 146-47 (1999). In this case, the RO substantially complied with the Board's remand instructions. Regarding the August 2009 remand, the Board instructed the RO to contact the National Personnel Records Center (NPRC) and request the Veteran's service personnel records. The RO requested the records and they were received and associated with the claims file. The Board also instructed that the NPRC should be asked to confirm the Veteran's dates of service in Japan, his units of assignment during that time, and whether any of these units used and/or stored toxic chemicals including herbicides and insecticides during that time. The RO requested information regarding the Veteran's assignment and the NPRC confirmed that the Veteran was assigned to HEDSUPPACT (headquarters support activity) Yokosuka Japan, and stationed at the Yokosuka Naval Base from March 1955 to December 1956. The RO apparently did not request information as to chemical or herbicide exposure; therefore, in the August 2011 remand, the Board noted that this portion of the instruction had not been completed. The Board instructed the RO to contact NPRC for confirmation as to whether the Veteran's unit used and/or stored toxic chemicals including herbicides and insecticides. The RO contacted the U.S. Joint Services Records Retention Center (JSRRC), which responded that there was no record of any tactical herbicides being used in Yokosuka during 1955 to 1956. The JSRRC directed the RO to contact the Navy and Marine Corps Public Health Center (NMCPHC) for additional information on non-Agent Orange environmental issues. The NMCPHC responded that it had no record of any possible exposure. In August 2009, the Board instructed the RO to request all records since 1999 regarding treatment from Kaiser for renal cancer. The RO wrote the Veteran a letter in November 2009 and asked him to provide the records from Kaiser or provide authorization for VA to obtain the records. The Veteran did not respond. The duty to assist is not a one-way street. See Wood v. Derwinski, 1 Vet. App. 190, 193 (1991). It is the responsibility of veterans to cooperate with VA. See Caffrey v. Brown, 6 Vet. App. 377, 383 (1994); Olson v. Principi, 3 Vet. App. 480, 483 (1992). The Board cannot obtain treatment records from a private provider without the Veteran's authorization. Regarding medical opinions, the August 2009 remand included instructions to obtain opinions regarding the etiology of alopecia, chronic foot infections, and peripheral neuropathy. An opinion was requested as to whether the claimed disabilities were caused or aggravated by military service, including the claimant's alleged exposure to toxic chemicals, including herbicides and insecticides. The instructions specified that the examiner should comment on a September 2007 medical opinion from a VA physician which appears to link the alopecia to the Veteran's alleged exposure to toxic chemicals including herbicides and insecticides while in military service, but is inconclusive. An examination was performed in April 2010, and the examiner commented on the September 2007 report and offered the requested etiology opinions. In sum, the Board finds that there has been substantial compliance with its remand instructions, and no additional remand for corrective action is necessary. Again, it is important for the Veteran to understand that additional development of this case, based on the facts presented (including, in some cases, the Veteran's own prior statements), will not provide a basis to grant any of the Veteran's claims. It was only with the grant of all benefit of the doubt that the Board was able to grant the neck disability in 2011. ORDER Service connection for peripheral neuropathy in the upper extremities is denied. Service connection for peripheral neuropathy in the lower extremities is denied. Service connection for a foot disability manifested by recurrent infections, to include osteomyelitis, is denied. Service connection for a disability manifested by hair loss, to include male pattern baldness and alopecia, is denied. Service connection for a disability of the kidney, to include cancer, is denied. ____________________________________________ JOHN J. CROWLEY Veterans Law Judge, Board of Veterans' Appeals Department of Veterans Affairs