Citation Nr: 1323958	
Decision Date: 07/26/13    Archive Date: 08/06/13

DOCKET NO.  07-37 593	)	DATE
	)
	)

On appeal from the
Department of Veterans Affairs Regional Office in Indianapolis, Indiana


THE ISSUE

Entitlement to service connecting for lung cancer, to include as secondary to Agent Orange exposure. 


REPRESENTATION

Appellant represented by:	Disabled American Veterans


ATTORNEY FOR THE BOARD

Carole Kammel, Counsel


INTRODUCTION

Please note this appeal has been advanced on the Board's docket pursuant to 38 C.F.R. § 20.900(c) (2012).  38 U.S.C.A. § 7107(a)(2) (West 2002).

The Veteran served on active duty from February 1968 to September 1970.  He served in the Republic of Vietnam (RVN) from July 1969 to September 1970. 

This matter comes before the Board of Veterans' Appeals  (Board) on appeal from a January 2007 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO) in Indianapolis, Indiana.  By that rating action, the RO, in pertinent part, denied service connection for lung cancer, to include as due to Agent Orange exposure.  The Veteran appealed the above-cited rating action to the Board.  

In August 2011 and May 2013, the Board remanded the claim on appeal to the RO for additional substantive development; specifically, to secure outstanding VA medical records and to schedule the Veteran for a VA examination.  The requested development has been accomplished and the appeal has returned to the Board for further appellate consideration. 

In June and July 2013, the Appeals Management Center (AMC) received additional evidence from the Veteran in support of his claim.  As the Veteran signed a waiver of initial RO consideration of this evidence in a written statement that same month, a remand to have the RO initially consider this evidence is not necessary.  38 C.F.R. § 20.1304 (2012). 


FINDINGS OF FACT

1.  The Veteran served in the RVN; thus, his exposure to Agent Orange (AO) is presumed.

2.  The Veteran's lung cancer metastasized from his nonservice-connected primary testicular carcinoma and did not manifest to a compensable degree within a year of the Veteran's discharge from military service and it is not etiologically related thereto, to include his presumed exposure to Agent Orange.  


CONCLUSION OF LAW

Lung cancer was not incurred in or aggravated by the Veteran's military service, and may not be presumed to have been incurred or aggravated therein, including from herbicide exposure in Vietnam.  38 U.S.C.A. §§ 1101, 1110, 1112, 1113, 1116, 1131, 5103, 5103A (West 2002 & Supp. 2012); 38 C.F.R. §§ 3.102, 3.159, 3.303, 3.307, 3.309 (2012). 


REASONS AND BASES FOR FINDINGS AND CONCLUSION

I. Duties to Notify and Assist

Before addressing the merits of the issue of entitlement to service connection for lung cancer, to include as due to Agent Orange exposure, VA has a duty to notify and a duty to assist claimants in substantiating a claim for VA benefits.  38 U.S.C.A. §§ 5103, 5103A; 38 C.F.R. §§ 3.159, 3.326(a).

Proper notice from VA must inform the claimant and his representative, if any, prior to the initial unfavorable decision on a claim by the agency of original jurisdiction (AOJ) of any information and any medical or lay evidence not of record (1) that is necessary to substantiate the claim; (2) that VA will seek to provide; and (3) that the claimant is expected to provide. 38 U.S.C.A. § 5103(a); 38 C.F.R. § 3.159(b); Mayfield v. Nicholson, 444 F.3d 1328 (Fed. Cir. 2006); Pelegrini v. Principi, 18 Vet. App. 112 (2004).  These notice requirements apply to all five elements of a service-connection claim (veteran status, existence of a disability, a connection between the veteran's service and the disability, degree of disability, and effective date of the disability).  Dingess v. Nicholson, 19 Vet. App. 473 (2006). Information that a disability rating and an effective date for the award of benefits will be assigned if service connection is awarded must be included.  Id.  

Neither the Veteran nor his representative has alleged prejudice with respect to notice, as is required.  See Shinseki v. Sanders, 129 S. Ct. 1696 (2009); Goodwin v. Peake, 22 Vet. App. 128 (2008).  None is found by the Board.  Indeed, VA's duty to notify has been more than satisfied.  The Veteran was notified via a pre-adjudication June 2006 letter of the criteria for establishing service connection, the evidence required in this regard, and his and VA's respective duties for obtaining evidence.   This letter addressed all notice elements and predated the initial adjudication of the service connection claim decided herein by the AOJ/RO in January 2007.  Nothing more was required.  The above-cited letter also informed the Veteran of how VA determines disability ratings and effective dates if service connection is awarded.  Dingess, supra.  

VA has also fulfilled its duty to assist the Veteran with respect to his claim on appeal.  VA has obtained the Veteran's service treatment records (STRs), DD 214, and voluminous post-service VA treatment and examination reports, to include those that have been uploaded to his Virtual VA electronic claims file.  In addition, relevant private treatment records and records from the Social Security Administration (SSA) have also been secured and associated with the claims file.  

As noted above, the issue on appeal was most recently remanded by the Board in May 2013 for further development.  Specifically, the Board instructed the RO, in pertinent part, to schedule the Veteran for a VA examination with an opinion to determine the  etiology of his testicular cancer, the Veteran's primary cancer, and its relationship, if any, to his presumed Agent Orange exposure.  VA examined the Veteran in June 2013.  A copy of the June 2013 VA examination report has been associated with the claims file.  The Board finds that the above-cited VA opinion is adequate to adjudicate the Veteran's claim as it was predicated on a full reading of the evidence of record. Specifically, the VA examiner based her opinion on a review of the Veteran's service treatment records (STRs), post-service treatment records, medical literature, and private medical opinion that is supportive of the claim.  

In a June 2013 written argument to VA, the Veteran's representative argued that the June 2013 VA examiner's opinion is inadequate for two reasons.  First, the Veteran's representative maintained that the June 2013 VA examiner's opinion was internally inconsistent because she initially stated that the cause of testicular cancer was unknown, but subsequently opined that it was not likely due to herbicide exposure.  (See June 2013 Veteran's representative's written argument to VA, page (pg.) 3)).  The Board has reviewed the June 2013 VA examiner's opinion and finds its contents to be consistent and non-contradictory.  The June 2013 VA examiner concluded that the cause of testicular cancer, as discussed in medical literature to include studies performed by the American Cancer Society, was unknown.  The VA examiner listed examples of risk factors for testicular cancer (e.g., race and taller-statured males), as they were known in the medical community.  Thus, when reading the VA examiner's June 2013 opinion in its entirely, she clearly explained that the cause of testicular cancer was unknown by the medical community at large.  

The Veteran's representative also maintained that the June 2013 VA examiner's opinion was inadequate because it was based on the premise that testicular cancer was not on [VA'S] presumptive list [for diseases subject to presumptive service connection per its regulations].  Id.  The Board does not find this interpretation of the VA examiner's comment, "Per further literature 'review,' testicular cancer is not considered a presumptive of Agent Orange" to be inadequate.  The VA examiner expounded on this statement by discussing medical literature issued by the American Cancer Society, wherein it was discussed that there was inadequate/insufficient evidence to determine an association between testicular cancer and Agent Orange.  (See June 2013 VA examination report).  Thus, in reading the June 2013 VA examiner's statement in its entirety and within the context of medical literature, the Board finds it to read that the medical community at large has found insufficient evidence to establish an etiological association between Agent Orange and testicular cancer, not that service connection for testicular cancer was not warranted because it was not a disease subject to presumptive service connection due to Agent Orange exposure in accordance with VA regulations.  Accordingly, the Board finds that there has been substantial compliance with its May 2013 remand directives with respect to the service connection issue on appeal.  See Stegall v. West, 11 Vet. App. 268 (1998); Dyment v. West, 13 Vet. App. 141, 146-47 (1999).  

Hence, no further notice or assistance is required to fulfill VA's duty to assist in the development of the claim decided herein.  Smith v. Gober, 14 Vet. App. 227 (2000), aff'd, 281 F.3d 1384 (Fed. Cir. 2002); Dela Cruz v. Principi, 15 Vet. App. 143 (2001); see also Quartuccio v. Principi, 16 Vet. App. 183 (2002).

II. Legal Criteria

Service connection-general criteria

Service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by service.  38 U.S.C.A. §§ 1110, 1131; 38 C.F.R. § +3.303(a). 

Service connection may also be granted for any disease diagnosed after discharge when all of the evidence 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) 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). 

In addition, certain chronic diseases, such as malignant tumors, may be presumed to have been incurred during service if they become manifested to a compensable degree within one year of separation from active duty.  38 U.S.C.A. §§ 1101, 1112, 1113, 1137; 38 C.F.R. §§ 3.307, 3.309; see also 67 Fed. Reg. 67792-67793 (Nov. 7, 2002).  

The second and third elements may be established by showing continuity of symptomatology.  Continuity of symptomatology may be shown by demonstrating "(1) that a condition was 'noted' during service or any applicable presumption period; (2) evidence of post-service continuity of the same symptomatology; and (3) medical or, in certain circumstances, lay evidence of a nexus between the present disability and the post-service symptomatology." Barr v. Nicholson, 21 Vet. App. 303, 307 (2007); Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007) (holding that "[w]hether lay evidence is competent and sufficient in a particular case is a factual issue to be addressed by the Board").  However, the United States Court of Appeals for the Federal Circuit (Federal Circuit) recently held that the theory of continuity of symptomatology can be used only in cases involving those conditions explicitly recognized as chronic in 38 C.F.R. § 3.309(a), such as malignant tumors.  Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013).  

When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, the Secretary shall give the benefit of the doubt to the claimant.  38 U.S.C.A. § 5107; 38 C.F.R. § 3.102; see also Gilbert v. Derwinski, 1 Vet. App. 49, 53 (1990).

Service Connection-Agent Orange criteria

Applicable regulations provide that a veteran who served on active duty in Vietnam during the Vietnam era is presumed to have been exposed to Agent Orange or similar herbicide.  38 C.F.R. § 3.307(a)(1)(6)(iii).  Here, the Board finds the Veteran is presumed to have been exposed to herbicides, since his DD Form 214 confirms he served in the RVN during the Vietnam War.  38 C.F.R. § 3.307(a)(6)(iii).

Diseases associated with exposure to certain herbicide agents used in support of military operations in the Republic of Vietnam during the Vietnam era will be presumed to have been incurred in or aggravated by service.  38 U.S.C.A. § 1116(a)(1); 38 C.F.R. § 3.307(a)(6).  The presumption requires exposure to an herbicide agent and manifestation of the disease to a degree of 10 percent or more within the time period specified for each disease.  38 C.F.R. § 3.307(a)(6)(ii). 

On October 13, 2009, in accordance with authority provided in 38 U.S.C. § 1116, the Secretary of VA announced his decision to establish presumptions of service connection, based upon exposure to herbicides used in the Republic of Vietnam during the Vietnam era, for three new conditions: ischemic heart disease, Parkinson's disease, and B cell leukemias.  On March 25, 2010, the Secretary published in the Federal Register a proposed rule that would amend 38 C.F.R. § 3.309(e)  to establish a presumption of service connection for ischemic heart disease, Parkinson's disease, and B cell leukemias based upon exposure to herbicides used in the Republic of Vietnam during the Vietnam era.  75 Fed. Reg. 14,391.  On August 31, 2010, the Secretary published in the Federal Register a final rule amending 38 C.F.R. § 3.309(e)  to establish such presumptions.  75 Fed. Reg. 53,202.  The final rule was effective August 31, 2010. 

Effective August 31, 2010, 38 C.F.R. § 3.309(e) provides that presumptive service connection based on Agent Orange exposure is available for the following diseases: 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 (including, but not limited to, acute, subacute, and old myocardial infarction; atherosclerotic cardiovascular disease including coronary artery disease (including coronary spasm) and coronary bypass surgery; and stable, unstable and Prinzmetal's angina); all chronic B-cell leukemias (including, but not limited to, hairy-cell leukemia and chronic lymphocytic leukemia); multiple myeloma; non-Hodgkin's lymphoma; Parkinson's disease; acute and subacute peripheral neuropathy; porphyria cutanea tarda; prostate cancer; respiratory cancers (cancer of the lung, bronchus, larynx, or trachea); soft-tissue sarcoma (other than osteosarcoma, chondrosarcoma, Kaposi's sarcoma, or mesothelioma). 

However, for purposes of this section, the term "ischemic heart disease" does not include hypertension or peripheral manifestations of arteriosclerosis such as peripheral vascular disease or stroke, or any other condition that does not qualify within the generally accepted medical definition of ischemic heart disease.  38 C.F.R. § 3.309(e), Note 3 (effective August 31, 2010). 

III. Merits Analysis

The Veteran seeks service connection for lung cancer.  He maintains that his lung cancer is due to exposure to Agent Orange during military service in the RVN.  (See VA Form 9, Appeal to Board of Veterans Appeals, received by the RO in November 2007).

The Veteran's STRs are wholly devoid of any clinical findings of any lung pathology, to include cancer.  A September 1970 service separation report reflects that the Veteran's lungs were evaluated as "normal."  A chest x-ray was within normal limits.  In the notes section of the report, the Veteran indicated that nothing had changed since his last physical examination (January 1968).  He described his condition as "good."  The examiner assigned the Veteran a numerical designation of 1 under P on the Veteran's physical profile, i.e., PULHES (PULHES is the six categories into which a physical profile is divided. The P stands for physical capacity or stamina; the U for upper extremities; the L for lower extremities; the H for hearing and ear; the E for eyes; and the S for psychiatric).  Then, as now, the number 1 indicated that an individual possessed a high level of medical fitness and, consequently, was medically fit at service discharge.  Odiorne v. Principi, 3 Vet. App. 456, 457 (1992). 

At the outset, the Board notes that the first post-service evidence of lung cancer was in the early 1990s.  A January 1992 report, prepared by R. R., M. D., Ph. D., indicated that a computed tomography scan (CT) scan of the Veteran's lungs confirmed a previous nodule on the left lower lobe and tiny nodule in the right upper lobe that represented a recurrence of the Veteran's testicular cancer.  A review of the treatment records shows that the Veteran's lung cancer had metastasized from his right testicle.  No contrary medical evidence has been received.  (Parenthetically, the Board observes that the first evidence of any right testicular cancer was also in the early 1990s.  A January 1992 report, prepared by J. C., M. D., reflects that the Veteran had developed a right testicular mass in April 1991, which was subsequently confirmed to have been testicular cancer.)  Thus, as the post-service medical evidence does not show that the Veteran's lung cancer was manifested to a compensable degree within a year of service discharge in 1970, service connection for a malignant tumor on a presumptive basis is not warranted. 38 C.F.R. §§ 3.307, 3.309 (2012). 

The Veteran's primary contention is that his lung cancer is due to his in-service AO exposure.  Although lung cancer is a presumptive disease as set forth in 38 C.F.R. § 3.309(3) as a disease that is subject to presumptive service connection as due to AO exposure, this presumption is rebuttable by affirmative evidence to the contrary.  Id.  Here, the competent and probative evidence of record shows that his lung cancer is secondary to his testicular cancer.  Thus, lung cancer cannot be presumptively service connected on the basis of herbicide exposure.  38 C.F.R. §§ 3.307, 3.309.  Significantly, where a cancer is not the primary cancer, but is merely the location where a primary cancer has metastasized, the secondary cancer cannot be considered presumptively related to herbicide exposure.  See VAOPGCPREC 18-97 (May 2, 1997) (metastasis represents the progress of the nonservice-connected primary cancer, and is affirmative evidence that the secondary cancer was not the result of some other cause, such as herbicide exposure).

However, a claimant is not precluded from presenting proof of direct service connection between a disorder and exposure to AO, even if the disability in question is not among statutorily enumerated disorders which are presumed to be service-related, the presumption not being the sole method for showing causation.  See Combee v. Brown, 34 F.3d 1039 (Fed. Cir. 1994) (holding that the veteran is not precluded from establishing service connection with proof of actual direct causation).

Thus, in view of the foregoing, the crux of the Veteran's claim hinges on whether there is an etiological relationship between his in-service Agent Orange exposure in the RVN and his post-service lung cancer.  There are private and VA opinions that are supportive of and against the claim, respectively. 

In support of the claim is an October 2011 report, prepared by B. D., M. D.  In that report, Dr. B. D. indicated that he had treated the Veteran for right testicular cancer in 1992.  Dr. B. D. opined, that the Veteran had been exposed to AO and that "it is possible that this may have some link to his testicular tumor."  (See October 2011 report, prepared by B. D., M. D.)  The Board finds Dr. B. D.'s opinion to be of minimal probative value for two reasons.  First, Dr. B. D.'s opinion is couched in speculative terms, "may have some link to his testicular tumor."  Under VA regulations and decisions of the United States Court of Appeals for Veterans Claims, service connection may not be based on pure speculation or remote possibility.  See 38 C.F.R. § 3.102 (2012); see also Davis v. West, 13 Vet. App. 178, 185 (1999); Perman v. Brown, 5 Vet. App. 237, 241 (1993).  Second, Dr. B. D. did not provide any medical reasoning for this speculative opinion.  Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 303-04 (2008); see also Gardin v. Shinseki, 613 F.3d 1374 (Fed.Cir. July 2010) (affirming the holding in Nieves-Rodriguez, id.)   

Evidence against the claim is a June 2013 VA nurse practitioner's opinion.  The VA nurse practitioner (NP) provided her opinion after a review of the Veteran's service treatment records, post-service VA and private treatment records, to include Dr. B. D.'s October 2011 opinion, physical examination of the Veteran and medical literature, such as studies performed by the American Cancer Society.  

The June 2013 VA NP concluded that it was less likely as not (less than 50 percent probability) that the Veteran's testicular cancer, the primary site of the Veteran's lung cancer, was caused by the claimed in-service injury, event or illness. The VA NP reasoned that per literature review, in most cases it was unclear what caused testicular cancer, and that it occurred in both older and younger men.  She listed certain risk factors for developing testicular cancer, such as a family history of an undescended testicle, Caucasian race and taller-statured males.  The VA NP noted that the Veteran had been diagnosed with testicular cancer in May 1991, according to a pathology report that showed a malignant germ cell tumor.  The VA NP indicated that nearly all testicular cancers began in the germ cells, but that the cause of the cancer in these cells was unknown.  

The VA NP concluded in June 2013 that according to review of medical literature, testicular cancer was not considered a presumptive of Agent Orange.  To this end, the VA NP pointed to studies from the American Cancer Society that showed that there was insufficient/inadequate evidence to determine an association between testicular cancer and AO exposure.  (See June 2013 VA examination report).  Thus, in reading the June 2013 VA examiner's statement in its entirety and within the context of medical literature, the Board finds it to read that the medical community at large has found insufficient evidence to establish an etiological association between Agent Orange and testicular cancer, not that service connection for testicular cancer was not warranted because it was not a disease subject to presumptive service connection due to Agent Orange exposure in accordance with VA regulations.  

The VA NP's June 2013 opinion is clearly based upon a comprehensive and factually accurate review of the record evidence from all sources and is therefore more probative than the speculative and conclusory statements of Dr. B. D.  Nieves-Rodriguez, supra.  Gardin v. Shinseki, 613 F.3d 1374 (Fed. Cir. July 2010) (affirming the holding in Nieves-Rodriguez, id.)  The Federal Circuit has recognized the Board's "authority to discount the weight and probity of evidence in light of its own inherent characteristics and its relationship to other items of evidence."  Madden v. Gober, 125 F.3d 1477, 1481 (Fed. Cir. 1997).  "It is not error for the BVA to favor the opinion of one competent medical expert over that of another when the Board gives an adequate statement of reason or bases.  It is the responsibility of the [Board] ... to assess the credibility and weight to be given to evidence." Owens v. Brown, 7 Vet. App. 429, 433 (1995). 

The VA NP provided a complete rationale for her opinion stated, relying on and citing to the Veteran's post-service medical record, to include Dr. B. D.'s October 2011 opinion and medical literature, to include studies performed by the American Cancer Society.  Nieves, supra.  The June 2013 VA NP specifically indicated that in formulating her opinions, she had relied on the fact that medical literature and studies had not affirmatively concluded that there was an association between AO exposure and testicular cancer.  For the above-cited reasons, the Board finds the VA NP's June 2013 opinion to be more consistent with the evidence of record than Dr. B. D.'s equivocal and conclusory opinion that is supportive of the claim.  

In support of his claim, the Veteran provided written statements to illustrate the fact that his lung and testicular cancers are the result of in-service exposure to Agent Orange in the RVN. The Board acknowledges that the Veteran is competent to testify as to his physical condition (i.e., he has difficulty breathing or pain in his chest), Jandreau v. Nicholson, 492 F.3d 1372, 1376-77 (Fed. Cir. 2007); Buchanan v. Nicholson, 451 F.3d 1331, 1336 (Fed. Cir. 2006), and lay witnesses may, in some circumstances, opine on questions of diagnosis and etiology.  See Davidson v. Shinseki, 581 F.3d 131, 1316 (Fed. Cir. 2009) (Board's categorical statement that "a valid medical opinion" was required to establish nexus, and that a layperson was "not competent" to provide testimony as to nexus because she was a layperson, conflicts with Jandreau). 

However, statements that his lung and testicular cancers are due to Agent Orange exposure is unlike testimony as to symptoms that are capable of direct observation (e.g., separated shoulder, varicose veins, or flat feet).  See Jandreau, 492 F.3d at 1376 (lay witness capable of diagnosing dislocated shoulder); Barr, 21 Vet. App. at 308-09 (lay testimony is competent to establish the presence of varicose veins); Woehlaert v. Nicholson, 21 Vet. App. 456, 462 (2007) (unlike varicose veins or a dislocated shoulder, rheumatic fever is not a condition capable of lay diagnosis).  The record does not show, nor does the Veteran contend, that he has specialized education, training, or experience that would qualify him to provide an opinion on this matter.  Accordingly, the Veteran's statements are entitled to limited or no probative value in this regard.  See Bostain v. West, 11 Vet. App. 124, 127 (1998); See also Routen v. Brown, 10 Vet. App. 183, 186 (1997).  More importantly, they are in direct conflict with the VA NP, a person who is qualified to provide an opinion as to the etiology of the Veteran's lung and testicular cancers.

As to any statements that the Veteran might proffer as to having had symptoms of lung cancer, the Board also finds that such statements, while competent, not credible.  This assertion is in direct conflict with the medical evidence of record showing that the Veteran initially developed lung cancer in 1991, over two (2) decades after service discharge in 1970.  As noted previously herein, the record shows no evidence of treatment for, or diagnosis of, lung cancer in service or until 1991.  With regard to the over two (2) decade-long evidentiary gap between the Veteran's discharge from service in 1970 and his diagnosis of lung and testicular cancers in the early 1990s, the Board notes that prolonged period without medical complaint can be considered, along with other factors concerning a claimant's health and medical treatment during and after military service, as evidence of whether an injury or a disease was incurred in service which resulted in any chronic or persistent disability.  See Maxson v. Gober 230 F.3d 1330, 1333 (Fed. Cir. 2000). 
The Board has found the preponderance of the evidence to be against the Veteran's proposition that his lung cancer was caused by his in-service AO exposure. 
In summary, the Board finds that the competent and probative medical and other evidence does not demonstrate that the Veteran's lung cancer was present until more than a year after service or that it was etiologically related to any incident of service including exposure to Agent Orange.  The Board therefore concludes that the preponderance of evidence is against the claim for service connection for lung cancer, to include as due to AO exposure.  In view of the foregoing, the benefit of the doubt doctrine is not for application, and the claim must be denied.  See Gilbert v. Derwinski, 1 Vet. App. 49 (1990); Ortiz v. Principi, 274 F.3d 1361 (Fed. Cir. 2001). 


ORDER

Service connection for lung cancer, to include as due to Agent Orange exposure, is denied. 



____________________________________________
BARBARA B. COPLEAND
Veterans Law Judge, Board of Veterans' Appeals


Department of Veterans Affairs