Citation Nr: 1319924 Decision Date: 06/20/13 Archive Date: 07/02/13 DOCKET NO. 08-14 784 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in Nashville, Tennessee THE ISSUES 1. Entitlement to service connection for a headache disorder, to include migraines. 2. Entitlement to service connection for chronic myeloid leukemia (CML), claimed as due to exposure to ionizing radiation. REPRESENTATION Appellant represented by: Veterans of Foreign Wars of the United States WITNESS AT HEARING ON APPEAL The Veteran ATTORNEY FOR THE BOARD J. H. Nilon, Counsel INTRODUCTION The Veteran served on active duty from February 1979 to July 1995. This matter comes before the Board of Veterans' Appeals (Board) on appeal of a July 2006 rating decision by the Department of Veterans Affairs (VA) Regional Office (RO) in Nashville, Tennessee. In October 2009 the Veteran testified before the undersigned Veterans Law Judge from the RO by videoconference. A transcript of the hearing is of record. The Board remanded these issues to the Agency of Original Jurisdiction in May 2010 for additional development, which has been accomplished. FINDINGS OF FACT 1. The Veteran has a chronic or recurrent headache disorder that became manifest during active service. 2. The Veteran performed security duties in a nuclear weapons storage area, but he did not participate in a radiation risk activity and is not shown to have been otherwise incidentally exposed to radiation. 3. The Veteran does not have CML that became manifest during service or to a compensable degree during the first year after discharge from service, nor is CML etiologically related to service. CONCLUSIONS OF LAW 1. A headache disorder was incurred in or aggravated by service. 38 U.S.C.A. §§ 1110, 1131, 1132, 1154(a), 5107(b) (West 2002); 38 C.F.R. §§ 3.102, 3.303, 3.304 (2012). 2. CML was not incurred in or aggravated by service, and incurrence in service of leukemia may not be presumed. 38 U.S.C.A. §§ 1110, 1131, 1154(a), 5107(b) (West 2002); 38 C.F.R. §§ 3.102, 3.303, 3.304, 3.307, 3.309, 3.311 (2012). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS Duties to Notify and Assist Before addressing the merits of the Veteran's claim on appeal, the Board is required to ensure that the VA's "duty to notify" and "duty to assist" obligations have been satisfied. See 38 U.S.C.A. §§ 5103, 5103A (West 2002); 38 C.F.R. § 3.159 (2012). The VA is required to assist a claimant in obtaining evidence necessary to substantiate a claim but is not required to provide assistance to a claimant if there is no reasonable possibility that such assistance would aid in substantiating the claim. The VA is required to notify a claimant and the claimant's representative, if any, of any information, and any medical or lay evidence, not previously provided to the Secretary that is necessary to substantiate the claim. As part of the notice, the VA is to specifically inform the claimant and the claimant's representative, if any, of which portion, if any, of the evidence is to be provided by the claimant and which part, if any, the VA will attempt to obtain on behalf of the claimant. In addition, the United States Court of Appeals for Veterans Claims (Court) has held that the plain language of 38 U.S.C.A. § 5103(a) requires that notice to a claimant be provided "at the time" of, or "immediately after," the VA's receipt of a complete or substantially complete application for VA-administered benefits. Pelegrini v. Principi, 18 Vet. App. 112, 119 (2004). VA must also notify the claimant that, should service connection be awarded, a disability rating and an effective date for the award of benefits will be assigned. Dingess v. Nicholson, 19 Vet. App. 473 (2006). The Veteran in this case was not provided complete notice prior to the July 2006 rating decision on appeal, in that he was not advised of the disability-rating and effective-date elements of a service connection claim prior to that decision. However, he was advised of those elements by a letter in October 2006, and the RO subsequently readjudicated the claim. Where there is a timing defect in a case, VA may cure the timing defect through compliance via proper remedial measures, such as the issuance of compliant VCAA notice followed by readjudication of the claim. Mayfield v. Nicholson, 444 F.3d 1328, 1333-34 (Fed. Cir. 2006). The readjudication may come in the form of the issuance of a SOC following the issuance of the VCAA notice. Mayfield v. Nicholson, 449 F.3d 1317, 1323-24 (Fed. Cir. 2007); Prickett v. Nicholson, 20 Vet. App. 370, 376-77 (2006). In any event, the Veteran has neither alleged nor demonstrated any prejudice with regard to the content or timing of the notice. See Shinseki v. Sanders, 129 S.Ct. 1696 (2009 (reversing prior cases law imposing a presumption of prejudice on any notice deficiency and clarifying that the burden of showing harmful or prejudicial error normally falls on the party attacking the agency's determination). See also Mayfield, 444 F.3d 1328, 1333-34. The record reflects that service treatment records (STRs), service personnel records and all available post-service medical evidence identified by the Veteran have been obtained. 38 C.F.R. § 3.311 imposes specific development requirements on VA for claims asserting entitlement to diseases associated with exposure to radioactivity, and as discussed in detail below those requirements have been accomplished. The Veteran has also been afforded a hearing before the Board. In Bryant v. Shinseki, 23 Vet. App. 488 (2010), the Court held that 38 C.F.R. § 3.103(c)(2) requires the hearing officer who chairs a hearing explain the issues and suggest the submission of evidence that may have been overlooked. Here, the presiding Veterans Law Judge identified the issues to the Veteran and asked specific questions directed at identifying whether the Veteran met the criteria for service connection. Additionally, the Veteran volunteered his treatment history and symptoms during and since service. Neither the Veteran nor his representative has asserted that VA failed to comply with 38 C.F.R. § 3.103(c)(2), nor have they identified any prejudice in the conduct of the Board hearing. The hearing focused on the elements necessary to substantiate the claims, and the Veteran provided testimony relevant to those elements. As such, the Board finds that there is no prejudice in deciding the claim at this time and no further action pursuant to Bryant is necessary. The Veteran has been not been afforded a medical examination in regard to the claim for service connection for CML. Here, nothing on file shows that the Veteran has the requisite knowledge, skill, experience, training, or education to render a medical opinion addressing the relationship between CML and radiation. As such, his contentions that he has CML due to in-service radiation exposure cannot constitute competent medical evidence. See Colantonio v. Shinseki, 606 F.3d 1378, 1382 (Fed. Cir. 2010) (recognizing that in some cases lay testimony "falls short" in proving an issue that requires expert medical knowledge); Waters v. Shinseki, 601 F.3d 1274, 1278 (Fed. Cir. 2010) (concluding that a Veteran's lay belief that his schizophrenia aggravated his diabetes and hypertension was not of sufficient weight to trigger the Secretary's duty to seek a medical opinion on the issue). Moreover, in light of the Board's finding that the Veteran was not exposed to ionizing radiation in service, the low threshold for a VA examination has not been met. See McLendon v. Nicholson, 20 Vet. App. 79 (2006). The Veteran has not made the RO or the Board aware of any additional evidence that needs to be obtained in order to fairly decide this appeal, and has not argued that any error or deficiency in the accomplishment of the duty to notify and duty to assist has prejudiced him in the adjudication of this appeal. Based on a review of the claims file, the Board finds that there is no indication in the record that any additional evidence relevant to the issue to be decided herein is available and not part of the claims file. See Mayfield, 499 F.3d 1317. Therefore, the Board finds that duties to notify and assist have been satisfied and will proceed to the merits of the issues on appeal Applicable Legal Principles Service connection may be granted for disability resulting from disease or injury incurred in or aggravated by active duty. 38 U.S.C.A. § 1110 (West 2002); 38 C.F.R. § 3.303 (2012). Service connection may be granted for any disease initially diagnosed after service when all the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d). Establishing service connection generally requires medical or, in certain circumstances, lay evidence of (1) a current disability; (2) an in-service incurrence or aggravation of a disease or injury; and (3) a nexus between the claimed in-service disease or injury and the present disability. See Davidson v. Shinseki, 581 F.3d 1313 (Fed.Cir.2009); Hickson v. West, 12 Vet. App. 247, 253 (1999); Caluza v. Brown, 7 Vet. App. 498, 506 (1995), aff'd per curiam, 78 F. 3d 604 (Fed. Cir. 1996) (table). Determinations as to service connection will be based on review of the entire evidence of record, to include all pertinent medical and lay evidence, with due consideration to VA's policy to administer the law under a broad and liberal interpretation consistent with the facts in each individual case. 38 U.S.C.A. § 1154(a); 38 C.F.R. § 3.303(a). Service connection may be presumptively granted for leukemia that becomes manifest within one year of discharge from service, even if not shown during service. 38 C.F.R. §§ 3.307, 3.309(a). A veteran is presumed to have been sound upon entry into the military, except as to conditions noted at the time of the acceptance, examination, or enrollment, or where clear and unmistakable evidence demonstrates that the condition existed before acceptance and enrollment and was not aggravated by such service. 38 U.S.C.A. §§ 1111, 1132. By "clear and unmistakable evidence" is meant that which cannot be misunderstood or misinterpreted; it is that which is undebatable. Vanerson v. West, 12 Vet. App. 254 (1999). In determining whether there is clear and unmistakable evidence to rebut the presumption of soundness, all evidence of record must be considered, including post service medical opinions. Harris v. West, 203 F.3d 1347 (Fed. Cir. 2000); Adams v. West, 13 Vet. App. 453 (2000). The VA General Counsel has issued a precedent opinion holding that to rebut the presumption of sound condition VA must show by clear and unmistakable evidence both that the disease or injury existed prior to service and that the disease or injury was not aggravated by service. VAOPGCPREC 3-03 (July 16, 2003). The claimant is not required to show that the disease or injury increased in severity during service before VA's duty under the second prong of this rebuttal standard attaches. Id. In its decisions, the Board is bound to follow the precedent opinions of the General Counsel. 8 U.S.C.A. § 7104(c). A preexisting injury or disease will be considered to have been aggravated by active service where there is an increase in disability during such service, unless there is a specific finding that the increase in disability is due to the natural progress of the disease. 38 C.F.R. § 3.306(a). However, the presumption of aggravation is applicable only if the pre-service disability underwent an increase in severity during service. Hunt v. Derwinski, 1 Vet. App. 292, 296 (1991); see also Beverly v. Brown, 9 Vet. App. 402, 405 (1996). Aggravation may not be conceded where the disability underwent no increase in severity during service on the basis of all the evidence of record pertaining to the manifestations of the disability prior to, during and subsequent to service. 38 C.F.R. § 3.306(b). In making all determinations, the Board must fully consider the lay assertions of record. A layperson is competent to report on the onset and continuity of his current symptomatology. See Layno v. Brown, 6 Vet. App. 465, 470 (1994) (a Veteran is competent to report on that of which he or she has personal knowledge). Lay evidence can also be competent and sufficient evidence of a diagnosis or to establish etiology if (1) the layperson is competent to identify the medical condition, (2) the layperson is reporting a contemporaneous medical diagnosis, or (3) lay testimony describing symptoms at the time supports a later diagnosis by a medical professional. Davidson, 581 F.3d 1313, 1316; Jandreau v. Nicholson, 492 F.3d 1372, 1376-77 (Fed. Cir. 2007). When considering whether lay evidence is competent the Board must determine, on a case-by-case basis, whether the Veteran's particular disability is the type of disability for which lay evidence may be competent. Kahana v. Shinseki, 24 Vet. App. 428 (2011); see also Jandreau, id. The Board is charged with the duty to assess the credibility and weight given to evidence. Madden v. Gober, 125 F.3d 1477, 1481 (Fed. Cir. 1997), cert. denied, 523 U.S. 1046 (1998); Wensch v. Principi, 15 Vet. App. 362, 367 (2001). Indeed, in Jefferson v. Principi, 271 F.3d 1072 (Fed. Cir. 2001), the United States Court of Appeals for the Federal Circuit (Federal Circuit), citing its decision in Madden, recognized that that Board had inherent fact-finding ability. Id. at 1076; see also 38 U.S.C.A. § 7104(a) (West 2002). Moreover, the United States Court of Appeals for Veterans Claims (Court) has declared that in adjudicating a claim, the Board has the responsibility to weigh and assess the evidence. Bryan v. West, 13 Vet. App. 482, 488-89 (2000); Wilson v. Derwinski, 2 Vet. App. 614, 618 (1992). As a finder of fact, when considering whether lay evidence is satisfactory, the Board may also properly consider internal inconsistency of the statements, facial plausibility, and consistency with other evidence submitted on behalf of the Veteran, and the Veteran's demeanor when testifying at a hearing. See Dalton v. Nicholson, 21 Vet. App. 23, 38 (2007); Caluza, 7 Vet. App. 498, 511. Except as otherwise provided by law, a claimant has the responsibility to present and support a claim for benefits under the laws administered by VA. VA shall consider all information and medical and lay evidence of record. Where there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, VA shall give the benefit of the doubt to the claimant. 38 U.S.C.A. § 5107; 38 C.F.R. § 3.102; see also Gilbert v. Derwinski, 1 Vet. App. 49, 53 (1990). The Board has reviewed all the evidence in the record. Although the Board has an obligation to provide adequate reasons and bases supporting this decision, there is no requirement that the evidence submitted by the appellant 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 file shows, or fails to show, with respect to the claim. See Gonzales v. West, 218 F.3d 1378, 1380-81 (Fed. Cir. 2000) and Timberlake v. Gober, 14 Vet. App. 122, 128-30 (2000). Evidence and Analysis Service connection for a headache disorder Service treatment records (STRs) do not include an enlistment physical examination. STRs document that during service the Veteran had a consultation request from psychiatry to internal medicine in February 1986 for evaluation of "probable migraines" but the resulting provisional diagnosis was somatization disorder. In May 1986 a psychiatry note shows the Veteran complaining of occasional tension headaches. In January 1987 the Veteran complained of frequent headaches. However, in a self-reported Report of Medical History in July 1989 the Veteran specifically denied history of frequent or severe headaches (the Veteran initially checked "yes" to this question but crossed it out and substituted "no" and initialed the correction). During audiological evaluation in January 1994 the Veteran complained of frequent headaches. The Veteran had a separation examination in March 1995 in which he submitted a Report of Medical History endorsing a history of frequent or severe headaches, but the corresponding Report of Medical Examination shows clinical evaluation of neurologic systems as "normal" and is silent in regard to a current chronic headache disorder. In May 1995, while still on active duty and awaiting discharge, he again presented to the dispensary complaining of headache. Also in May 1995, an ophthalmology note showed an impression of "probable migraines" and a neuropsychology examination recorded a complaint of monthly headaches sometimes accompanied by mild dizziness. A July 1995 neurology consult noted an impression of migraine headaches (complicated). The Veteran was discharged from active duty in July 1995; he immediately submitted an initial claim to VA for disability compensation for numerous disorders including migraine headaches. A rating decision by the RO in June 1996 denied service connection for numerous claimed disorders, including migraines. The Veteran submitted a Notice of Disagreement (NOD) in regard to the June 1996 rating decision that was dated on June 10, 1997, but date-stamped as received by the RO on June 13, 1997. As the NOD was not received within the one-year appeal period, the June 1996 denial of service connection for migraines became final. The Veteran presented to the VA emergency room in November 2004 complaining of intermittent headache and neck pain for the past month. He reported a history of recurring classic migraine headaches since childhood, with a period of being headache-free for a few years after adolescence. The clinical diagnosis was cephalgia and migraine with aura, mixed with muscular contractions. The Veteran had a follow-up at the VA primary care clinic in December 2004 during which he reported having had headaches "forever." He reported that doctors in service had characterized the headaches as migraines but complained that migraine medications had not been effective. The Veteran denied photophobia or other classic migraine symptoms. The clinical assessment following examination was mixed vascular/muscular headaches. Thereafter, the Veteran had a follow-up at the VA neurology clinic in December 2004. He complained of headaches with photophobia and phonophobia; he endorsed nausea but denied vomiting. The clinical impression was headaches with history of migraine and history of mixed-type headaches. The Veteran presented to the VA neurology clinic in April and May 2005 with renewed complaint of headaches with associated nausea. The clinical impression on both occasions was migraine headaches. The Veteran had a VA neurology consultation in June 2005 in which he reported a migraine headache disorder dating back to his childhood. He endorsed a family history of migraines, including two daughters, his mother and his grandfather. The clinical impression was history of debilitating occipital or temporal headaches. The Veteran submitted a new claim for service connection for migraine headaches in August 2004. The July 2006 rating decision on appeal denied reopening the claim, based on a finding that new and material evidence had not been received, but the Board subsequently reviewed the file on appeal and reopened the previously-denied claim for adjudication of the merits. The Veteran presented to the VA neurology clinic in April 2007 with complaints including headaches that waxed and waned; he reported he could sometimes go a month or so without any headaches and then have daily headaches for another month or so. The clinical impression was headaches, possible migraine or cluster variant or tension. Neck pain and stress appeared to be a factor. The Veteran presented to the VA neurology clinic in September 2007 again complaining of waxing and waning headaches. The clinical impression was multifactoral headaches, migraine or cluster variant or tension. The Veteran's symptoms appeared to involve the neck; psychological stress was also a factor. The Veteran testified before the Board in October 2009 that he first began experiencing migraine headaches in 1986; he denied having had headaches prior to active service. He stated that migraines per se were not documented during service because such diagnosis would have required treatment with narcotic medications, which would have been incompatible with his duties. The Board remanded the case in May 2010 for the purpose of providing the Veteran a VA examination. The examination was performed in August 2011, by a physician who reviewed the claims file and the VA medical record. The Veteran reported a history of headaches "as long as I can remember" and dating back to his childhood; he also stated that many other family members had headaches. The examiner reviewed the medical history relating to headaches as documented in STRs and post-service treatment records. The examiner noted the Veteran was a poor historian who had given conflicting histories over the years; he would always come for follow-up stating he could not take the prescribed medications because of side effects. The examiner stated that it was established and conceded that the Veteran had headaches prior to service, but that such headaches were not likely aggravated during service. The examiner stated as rationale that the Veteran had some tension headaches in service but did not respond to migraine medications. The examiner also stated the Veteran's current headache disorder did not constitute migraines; instead, the examiner diagnosed headaches of unknown type. Review of the evidence shows the Veteran was treated during service for recurrent headaches, variously diagnosed, and that since service he has continued to be treated for a chronic or at least recurrent headache disorder, variously diagnosed. The threshold for finding a link between current disability and service is low; Locklear v. Nicholson, 20 Vet. App. 410 (2006). As STRs do not include an enlistment physical, the Veteran is generally considered to be sound at the time of his entry into service. The Veteran has recounted to various providers and examiners that he had headaches during childhood (although he denied such headaches when testifying before the Board), but a layperson's account does not constitute the type of evidence that would serve as the basis for a finding that a condition preexisted service. Paulson v. Brown, 7 Vet. App. 466 (1995). The VA examiner in August 2011 expressed a medical opinion that the Veteran's headache disorder preexisted service. If the Board accepts this opinion as clear and unmistakable evidence that the disorder preexisted service, then the presumption of aggravation applies, absent clear and unmistakable evidence that the disorder was not aggravated beyond the normal course of the disease during service. The examiner stated an opinion that the preexisting headache disorder was "not likely" aggravated during service, but "not likely" does not approximate the "clear and unmistakable evidence" standard necessary to rebut the presumption of soundness. Thus, consistent with the Veteran's statements, the medical evidence clearly and unmistakably shows that his headaches existed prior to service. The medical evidence, however, does not clearly and unmistakably reflect that the condition was not aggravated by such service. Thus, because he was normal at service entrance with respect to this disability, and since the evidence does not clearly and unmistakably show that his headaches both existed prior to service and was not aggravated by service, (and she currently suffers from allergic rhinitis), the criteria for service connection have been met. Service connection for CML STRs show no indication of leukemia in service or during the first year after discharge from service. VA treatment records show that CML was first identified in July 2005, 10 years after discharge from service. The Board accordingly finds that presumptive service connection for leukemia under 38 C.F.R. § 3.309(a) is not applicable. The Veteran asserts he developed CML as a result of exposure to nuclear radiation while serving as a security guard on nuclear weapons during service. Leukemia (other than chronic lymphocytic leukemia) may be presumptively service-connected if becomes manifested within a radiation-exposed veteran. 38 C.F.R. § 3.309(d). A "radiation-exposed veteran" means a veteran who while serving on active participated in a radiation-risk activity. 38 C.F.R. § 3.309(d)(3)(i). The term "radiation risk activity" means onsite participation in a test involving the atmospheric detonation of a nuclear device; participation in the postwar occupation of Hiroshima or Nagasaki, Japan during the period August 1945 to July 1946 ; internment as a prisoner of war in Japan or service on active duty in Japan immediately following such internment immediately after World War II that resulted in an opportunity for exposure to ionizing radiation comparable to that of United States occupation forces in Hiroshima or Nagasaki during the period August 1945 to July 1946; service in which the servicemember was, as part of his or her duties, present during a total of at least 250 days before February 1, 1992, on the grounds of a gaseous diffusion plant located in Paducah, Kentucky, Portsmouth, Ohio, or the area identified as K25 at Oak Ridge, Tennessee, under certain conditions; service before January 1, 1974, on Amchitka Island, Alaska, of during such period the veteran was exposed to ionizing radiation related to underground nuclear tests; or, service in a capacity which, if performed as an employee of the Department of Energy, would qualify the individual for inclusion as a member of the Special Exposure Cohort under the Energy Employees Occupational Illness Compensation Program. The record does not show, and the Veteran does not allege, that he participated in any of the activities cited above. He is accordingly not entitled to presumptive service connection as a "radiation exposed veteran" within the meaning of 38 C.F.R. §§ 3.309(d) and 3.311. The Veteran submitted a letter in January 2006 reporting that during service he was exposed to radiation while serving as a military policeman (MP) performing security duties at a nuclear storage site in Germany in 1985-86. During that time he came into direct physical contact with nuclear weapons; although the guards were told the weapons were completely safe the guards would sometimes put their hands on the weapons on cold days to feel the heat radiating from them. The Veteran also reported that while serving at Fort Lewis during the period 1994-95 he was a physical security inspector and was exposed to depleted uranium ammunition for armored vehicles, as well as generally exposed to toxins associated with motor pools, arms rooms and storage sites. The rating decision on appeal was issued in July 2006. In his NOD, received in September 2006, the Veteran stated that while in service he worked on "nukes" and uranium-tipped rounds. He also stated that during service he had to [illegible] IM-93 radiation counters. In July 2007 the RO sent a letter to the Director of the Proponency Office for Preventive Medicine (POPM), U.S. Army Medical Command, requesting documentation that the Veteran had been exposed to ionizing radiation during service. POPM responded in August 2007 that the claim could not be adequately assessed without further documentation from VA to include a list of the radioactive commodities and radiation-producing devices to which the Veteran was exposed, records relating to the hours spent per day working with radioactive sources and radiation-producing devices, copies of radiation dose records and medical records showing treatment for any occupational radiation injuries, etc. In October 2007 POPM forwarded a request to the Commander, U.S. Army Center for Health Promotion and Preventive Medicine, for documentation regarding the Veteran being exposed to radiation during service. The RO followed up this request in December 2007. That office responded in February 2008 that in coordination with the Veteran Radiation Exposure Investigations Program (VREIP) and the U.S. Army Dosimetry Center (USADC) (which is the Army's repository for historical records of occupational radiation dosimetry) there was no record of the Veteran having been occupationally exposed to ionizing radiation during service. The Veteran testified before the Board in October 2009 that while stationed in Germany he performed security duties in a nuclear weapons storage area. His duties did not involve opening such weapons but did involve drills such as simulating destruction of those weapons. During those drills, the teams entering the bunkers would carry IM-93 dosimeters. On one occasion the person on his team who was carrying the dosimeter said the reading was "kind of hot" but he did not report it because doing so would "make a stink." The Veteran testified these weapons sometimes felt warm to the touch. He stated that the security personnel did not go into the bunkers daily, but just "once in awhile" to perform drills. The Veteran also testified that during another assignment, this time at Fort Lewis, he served as physical security inspector. This entailed going into motor pools, arms room and ammunition storage areas. This exposed him to depleted-uranium tank rounds. The Veteran asserted that he had been told by VA physicians that he had a rare type of leukemia that is associated with exposure to radiation. However, those physicians declined to give the Veteran a written statement to that effect. The Board remanded the case in May 2010 for the purpose of obtaining the Veteran's service personnel record, in order to determine if there is documentation therein of nuclear-related duties. Service personnel records confirm the Veteran served in Germany and at Fort Lewis at the times he asserts, but are otherwise silent in regard to whether he performed duties in nuclear weapons storage areas. In that regard, personnel whose duties involve access to nuclear weapons, including security, are required to be screened under the Personnel Reliability Program (PRP), but only reference to PRP in the service personnel record is an ambivalent entry on the Personnel Qualification Record (PQR) stating "PER RLBTY PGM ASSGN STS: NONE" (PRP assignment status: none). Review of the file shows the Veteran is competently diagnosed with CML. Accordingly, the first element of service connection - medical evidence of a disability - is met. However, a veteran seeking disability benefits must establish not only the existence of a disability, but also an etiological connection between his military service and the disability. Boyer v. West, 210 F.3d 1351, 1353 (Fed. Cir. 2000); D'Amico v. West, 209 F.3d 1322, 1326 (Fed. Cir. 2000). As noted above, the presumptions of 3.309(a) (chronic disease) and 3.309(d) (radiogenic disease) do not apply in this case, and there is no indication that CML became manifest until ten years after discharge from service. The Veteran asserts his belief that CML is due to his duties guarding nuclear weapons. The file does not document that the Veteran performed such duties, but his report is consistent with his military occupational specialty (MOS) and his dates of assignment as shown in the service personnel record. However, even if performance of duties in nuclear weapons storage sites is conceded, STRs and service personnel records do not include dosimeter readings or other indications that such duties actually exposed the Veteran to nuclear radiation. In that regard, the Board is unaware of any instance in which routine handling of nuclear warheads, depleted uranium ammunition rounds, or similar devices either in depot or in the field (such as handling for inventory, maintenance, transportation, mating to delivery systems, etc.) has ever resulted in radiation exposure, nor has the Veteran cited such an instance. The Board has carefully considered the Veteran's account of an incident in which he was part of a team that had a "kind of hot" dosimeter reading while performing duties in a storage bunker. Such an incident was not confirmed by USADC, but this is arguably explained by the Veteran's account that the team did not report the incident at the time. The Board cannot find that the Veteran's recollection constitutes credible evidence of a significant radiation exposure. Failure to report an abnormally high radiation level would have been gross dereliction of duty and would have imposed significant future risk for personnel working in that area, including the team in question. Further, if the dosimeter reading had been abnormally high the team members would have sought medical treatment out of self-interest. Accordingly, the Board finds the Veteran's report of a "kind of hot" reading is not credible. The Veteran has asserted that VA physician informed him that he has a type of leukemia that is consistent with radiation exposure. However, as there is no objective evidence of radiation exposure in service, such opinions do not constitute medical evidence of a nexus to service. In sum, based on the evidence and analysis above, the Board finds the preponderance of the evidence shows that Veteran's CML is not etiologically related to service, to include claimed exposure to radiation during service. As such, the criteria for service connection are not met and the claim must be denied. ORDER Service connection for a headache disorder is granted. Service connection for chronic myeloid leukemia is denied. ____________________________________________ STEVEN D. REISS Veterans Law Judge, Board of Veterans' Appeals Department of Veterans Affairs