Citation Nr: 1552054 Decision Date: 12/11/15 Archive Date: 12/16/15 DOCKET NO. 11-12 979 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in Atlanta, Georgia THE ISSUES 1. Entitlement to service connection for a respiratory disorder, claimed as breathing problems, to include as due to herbicide or asbestos exposure. 2. Entitilement to service connection for squamous cell carcinoma, claimed as skin cancer, to include as due to herbicide exposure. REPRESENTATION Appellant represented by: Georgia Department of Veterans Services WITNESSES AT HEARING ON APPEAL Appellant and his spouse ATTORNEY FOR THE BOARD J. T. Brant, Associate Counsel INTRODUCTION The Veteran served on active duty from March 1964 to August 1967. These matters come before the Board of Veterans' Appeals (Board) on appeal from a June 2009 rating decision by a Department of Veterans Affairs (VA) Regional Office (RO). In February 2015, the Veteran testified at a Videoconference hearing before the undersigned Veterans Law Judge; a transcript of the hearing is associated with the electronic claims file. In May 2015, the Board remanded the case for further development. The matter is back before the Board for further appellate proceedings. This is a paperless appeal located on the Veterans Benefits Management System (VBMS). Documents on the Virtual VA paperless claims processing system are either duplicative of the evidence of record or not pertinent to the present appeal. FINDINGS OF FACT 1. The Veteran had active military service in the Republic of Vietnam during the Vietnam era, and is presumed to have been exposed to Agent Orange and/or other herbicide agents. 2. The preponderance of the evidence is against a finding that a respiratory disorder, diagnosed as wheezing and exertional dyspnea, was caused by or is otherwise related to the Veteran's active service, to include as due to exposure to asbestos or herbicide agents therein. 3. The preponderance of the evidence is against a finding that the Veteran's squamous cell carcinoma was caused by or is otherwise related to his active service, to include as due to exposure to herbicide agents therein. CONCLUSIONS OF LAW 1. A respiratory disorder, diagnosed as wheezing and exertional dyspnea, was not incurred in service and is not otherwise related to service, to include asbestos or herbicide exposure in service. 38 U.S.C.A. § 1110, 1112, 1113, 5103, 5103A, 5107 (West 2014); 38 C.F.R. §§ 3.102, 3.159, 3.303, 3.304, 3.307, 3.309 (2015). 2. Squamous cell carcinoma was not incurred in service and is not otherwise related to service, to include herbicide exposure in service. 38 U.S.C.A. § 1110, 1112, 1113, 5103, 5103A, 5107 (West 2014); 38 C.F.R. §§ 3.102, 3.159, 3.303, 3.304, 3.307, 3.309 (2015). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS I. Stegall Concerns As noted in the Introduction, the Board remanded the Veteran's claims in May 2015 for additional evidentiary development. In particular, the Board remanded the Veteran's claim for entitlement to service connection for a respiratory disability for a VA examination with an etiology opinion. The Board remanded the Veteran's claim for skin cancer to obtain any outstanding treatment records, to include treatment records from Dr. R. related to his skin cancer dated in the 1970's, and a VA examination with an etiology opinion. In July 2015, the RO requested that the Veteran provide the names and addresses of any and all health care providers who have provided treatment for his claimed disabilities, to include authorization to obtain medical records from Dr. R. related to his skin cancer. The Veteran did not respond to the RO's request. After obtaining examinations and etiology opinions for the Veteran's claimed respiratory disorder and skin cancer in August 2015, the RO then readjudicated the Veteran's claims in an October 2015 supplemental statement of the case. For the reasons discussed below, the Board finds that the August 2015 examiners provided adequate rationales for the opinions. The Board does not that only one issue was listed on the title page of the supplemental statement of the case. However, both issues were specifically adjudicated in the text of that document. Thus, with respect to the claims, the Board's prior remand instructions have been substantially complied with. See Stegall v. West, 11 Vet. App. 268, 271 (1998) [where the remand orders of the Board are not complied with, the Board errs as a matter of law when it fails to ensure compliance]. II. The Veterans Claims Assistance Act of 2000 (VCAA) The VCAA, codified in part at 38 U.S.C.A. §§ 5103, 5103A, and implemented in part at 38 C.F.R. § 3.159, amended VA's duties to notify and to assist a claimant in developing information and evidence necessary to substantiate the claim. Duty to Notify Under 38 U.S.C.A. § 5103(a) and 38 C.F.R. § 3.159(b), when VA receives a complete or substantially complete application for benefits, it will notify the claimant of (1) any information and medical or lay evidence that is necessary to substantiate the claim, (2) what portion of the information and evidence VA will obtain, and (3) what portion of the information and evidence the claimant is to provide. The VCAA notice requirements apply to all five elements of a service connection claim. The five elements are: (1) veteran status; (2) existence of a disability; (3) a connection between the veteran's service and the disability; (4) degree of disability; and (5) effective date of the disability. Dingess v. Nicholson, 19 Vet. App. 473 (2006). The VCAA notice must be provided to a claimant before the initial unfavorable adjudication by the RO. Pelegrini v. Principi, 18 Vet. App. 112 (2004). The Board finds that VA has satisfied its duties to notify the appellant under the VCAA. Letters dated in December 2008 and March 2009 notified the Veteran of the evidence needed to substantiate the claims for service connection, as well as what information and evidence must be submitted by the Veteran, what information and evidence would be obtained by VA, and the provisions for disability ratings and for the effective date of the claims. Duty to Assist VA has fulfilled its duty to assist in obtaining identified and available evidence needed to substantiate the claims. Service treatment records, identified post-service treatment records, and lay statements have been associated with the record. As discussed above, in his February 2015 Videoconference hearing, the Veteran testified that he was first diagnosed with skin cancer in 1970 by Dr. R. The Veteran indicated that Dr. R. was retired and possibly deceased. In October 2008, the Veteran submitted a VA Form 21-4142, Authorization and Consent to Release Information to the Department of Veterans Affairs, for Dr. R. for treatment for his skin cancer from "1980 to current." The Board notes that although the file contains treatment records from Dr. R., these records begin in the 1990's. In July 2015, the RO requested that the Veteran provide the names and addresses of any and all health care providers who have provided treatment for his claimed disabilities, to include authorization to obtain medical records from Dr. R. related to his skin cancer. The Veteran did not respond to the RO's request. As discussed above, VA examinations for the claimed respiratory and skin cancer disorders were obtained in August 2015. The examinations included opinions which discussed the etiology of the Veteran's diagnosed disorders. The opinions provided were thorough and fully adequate. See Barr v. Nicholson, 21 Vet. App. 303 (2007). As part of the duty to assist, the Veteran was afforded a Board hearing pursuant to his request. In Bryant v. Shinseki, 23 Vet. App. 488 (2010), the Court held that 38 C.F.R. § 3.103(c)(2) requires that the Veterans Law Judge of the Board or local Decision Review Officer (DRO) at the RO chairing a hearing fulfill two duties to comply with this VA regulation. These duties consist of (1) fully explaining the issue, and (2) suggesting the submission of evidence that may have been overlooked and that may be advantageous to the claimant's position. Here, during the Board hearing, the undersigned effectively outlined the issues on appeal and suggested that any evidence that may be advantageous to the Veteran's position be submitted. To the extent this was not done, the Veteran and his representative at the hearing demonstrated sufficient actual knowledge of what was required. Moreover, neither the Veteran nor his representative has asserted that VA failed to comply with 38 C.F.R. § 3.103(c)(2); they have not identified any prejudice in the conduct of the hearing. As the Veteran has not identified any additional evidence pertinent to the claims, the Board concludes that no further assistance to the Veteran in developing the facts pertinent to the claims is required to comply with the duty to assist. III. Service Connection A veteran is entitled to VA disability compensation if there is disability resulting from personal injury suffered or disease contracted in line of duty in active service, or for aggravation of a preexisting injury suffered or disease contracted in line of duty in active service. 38 U.S.C.A. § 1110. Generally, to establish a right to compensation for a present disability, a veteran must show: (1) a present disability; (2) an in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the present disability and the disease or injury incurred or aggravated during service, the so-called "nexus" requirement. Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004). Service connection means that the facts, shown by evidence, establish that a particular injury or disease resulting in disability was incurred coincident with service, or if preexisting such service, was aggravated by service. This may be accomplished by affirmatively showing inception or aggravation during service. 38 C.F.R. § 3.303(a). In order to show a 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 fact of chronicity in service is not adequately supported, then a showing of continuity after discharge is required to support a claim. There must be competent medical evidence unless the evidence relates to a condition as to which lay observation is competent to identify its existence. See 38 C.F.R. § 3.303(b). Service connection may also 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). Alternatively, 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 U.S.C.A. § 1116(f) (West 2014); 38 C.F.R. § 3.307(a)(6)(iii) (2015). If a veteran was exposed to a herbicide agent during active military, naval, or air service, certain diseases shall be service connected if the requirements of 38 U.S.C.A. § 1116 and 38 C.F.R. § 3.307(a)(6)(iii) are met, even though there is no record of such disease during service, provided further that the rebuttable presumption provisions of 38 U.S.C.A. § 1113; 38 C.F.R. § 3.307(d) are also satisfied. 38 C.F.R. § 3.309(e). VA has determined there is no positive association between exposure to herbicides and any other condition for which the Secretary has not specifically determined that a presumption of service connection is warranted. See Notice, 68 Fed. Reg. 27630 -27641 (2003). A presumption of service connection based on exposure to herbicides used in the Republic of Vietnam during the Vietnam Era is not warranted for various conditions and any other condition for which the Secretary has not specifically determined a presumption of service connection is warranted. See Notice, 72 Fed. Reg. 32,395-32,407 (Jun. 12, 2007); see also Notice, 74 Fed. Reg. 21,258 -21260 (May 7, 2009). Notwithstanding the foregoing, regulations also provide that service connection may be granted for any disease diagnosed after discharge, when all evidence, including that pertinent to service, establishes that the disability was incurred in service. 38 C.F.R. § 3.303(d); Combee v. Brown, 34 F.3d 1039 (Fed. Cir. 1994). A presumption of service connection provided by law is not the sole method for showing causation in establishing a claim for service connection for disability due to herbicide exposure. Stefl v. Nicholson, 21 Vet. App. 120 (2007) (holding that the availability of presumptive service connection for some conditions based on exposure to Agent Orange does not preclude direct service connection for other conditions based on exposure to Agent Orange). IV. Respiratory Disorder The Veteran is seeking service connection for a respiratory disorder, claimed as breathing problems, and diagnosed as "wheezing" and "exertional dyspnea." Specifically, he contends that he developed his current respiratory disorder as a result of exposure to asbestos and/or herbicides when he served aboard the USS Estes and in Vietnam. There is no specific statutory or regulatory guidance with regard to claims for service connection for asbestos-related diseases. However, in 1988 VA issued a circular on asbestos-related diseases which provided guidelines for considering asbestos compensation claims. See Department of Veterans Benefits, Veterans Administration, DVB Circular 21-88-8, Asbestos-Related Diseases (May 11, 1988). The information and instructions contained in the DVB Circular have since been included in VA Adjudication Procedure Manual, M21-1, part VI, para. 7.21 (Oct. 3, 1997) (hereinafter "M21-1"). Subsequently, an opinion by the VA General Counsel discussed the development of asbestos claims. VAOPGCPREC 4-2000 (April 13, 2000). The Board notes that the aforementioned provisions of M21-1 were rescinded and reissued as amended in a Manual rewrite (MR) in 2005. See M21-1MR, Part IV, Subpart ii, Chap. 1, Sec. H, Para. 29, entitled "Developing Claims for Service Connection for Asbestos-Related Diseases," and Part IV, Subpart ii, Chap. 2, Sec. C, Para. 9, entitled "Service Connection for Disabilities Resulting from Exposure to Asbestos." VA must analyze the Veteran's claim of entitlement to service connection for an asbestos-related respiratory disability under these administrative protocols using the following criteria. Ennis v. Brown, 4 Vet. App. 523, 527 (1993); McGinty v. Brown, 4 Vet. App. 428, 432 (1993). The latency period for asbestos-related diseases varies from 10 to 45 or more years between first exposure and development of disease. The exposure may have been direct or indirect, and the extent or duration of exposure is not a factor. M21-1MR, Part IV, Subpart ii, Chap. 1, Sec. H, Para. 29a. The Manual provisions acknowledge that inhalation of asbestos fibers and/or particles can result in fibrosis and tumors, and produce pleural effusions and fibrosis, pleural plaques, mesotheliomas of the pleura and peritoneum, and cancer of the lung, gastrointestinal tract, larynx, pharynx and urogenital system (except the prostate), with the most common resulting disease being interstitial pulmonary fibrosis (asbestosis). Also noted is the increased risk of bronchial cancer in individuals who smoke cigarettes and have had prior asbestos exposure. As to occupational exposure, exposure to asbestos has been shown in insulation and shipyard workers, and others. The clinical diagnosis of asbestosis requires a history of exposure and radiographic evidence of parenchymal lung disease. M21-1MR, Part IV, Subpart ii, Chap. 2, Sec. C, Para. 9a-f. The Manual further provides that VA must determine whether military records demonstrate evidence of asbestos exposure in service; whether there is pre-service and/or post-service evidence of occupational or other asbestos exposure; and then make a determination as to the relationship between asbestos exposure and the claimed diseases, keeping in mind the latency and exposure information pertinent to the veteran. M21-1MR, Part IV, Subpart ii, Chap. 2, Sec. C, Para. 9h. As an initial matter, the Board notes that the Veteran has been diagnosed with wheezing and exertional dyspnea. The Veteran's service personnel records revealed that he served on active duty with the United States Navy from March 1964 to August 1967. The Veteran's military occupational specialty was listed as a "Boatswain's Mate," which would likely have resulted in minimal asbestos exposure. The Board finds the Veteran's statements of in-service exposure to asbestos to be competent, credible, and consistent with the circumstances of his service in the Navy. The Board thus accepts that the Veteran was exposed to asbestos. Here, the Board finds no competent evidence that attributes the Veteran's diagnosed respiratory disorders of wheezing and exertional dyspnea to active duty, to include exposure to asbestos or herbicides. At the outset, the Board finds that the Veteran's diagnosed respiratory disorders of wheezing and exertional dyspnea are not related to his herbicide exposure during service. Wheezing and exertional dyspnea are not on the list of diseases that VA has associated with Agent Orange exposure. The scientific studies reviewed as part of that regulatory process have associated certain respiratory cancers with herbicide exposure, but not wheezing or exertional dyspnea. Moreover, the evidence does not link any diagnosed respiratory disorder to the Veteran's period of active service, to include asbestos exposure. The evidence does not reflect that the Veteran had a respiratory disorder in service or for many years thereafter. The Veteran's service treatment records showed no diagnosis, treatment, or complaints for a respiratory condition. A chest x-ray dated in February 1965 was essentially negative. On examination at separation from service in July 1967, the Veteran's lungs were evaluated as normal. Post-service treatment records revealed breathing problems beginning in or around 2007 or 2008. In a chest x-ray dated in October 2006, a basilar linear density was present, consistent with atelectasis and/or scarring. The lungs were otherwise clear. The impression was negative for evidence of acute intrathoracic disease. In a November 2008 private treatment record, the Veteran complained of dyspnea, wheezing, and cough with white sputum. On examination, the lungs were clear to auscultation. In a chest x-ray dated in November 2008, the impression was status post coronary artery bypass grafting (CABG), otherwise unremarkable chest. A VA problem list dated in 2008 noted a diagnosis of "wheezing." In a VA treatment record dated in December 2008, the Veteran reported potential asbestos exposure while serving on a ship in the Navy. The Veteran denied shortness of breath. No further testing was performed. On pulmonary examination, there was no cough. The Veteran had exertional shortness of breath, which was worsening over the past several years. The physician noted that a chest x-ray done by a local physician showed interstitial scar tissue without mass or infiltrate. The physician noted that the Veteran had not had computed tomography (CT) or pulmonary function testing. The physican noted occasional wheezing, but no pain with breathing. The assessment was exertional shortness of breath, with recent chest x-ray showing interstitial scarring. In a CT scan dated in February 2009, there was no evidence of prior asbestos exposure or asbestosis. There was no evidence of interstitial lung disease; there were no pleural or pericardial effusions or pleural plaques. The CT scan revealed a tiny subpleural left lower lobe nodule, which was described to be likely post-infectious or post-inflammatory in nature. It was noted that in the absence of a history of tobacco abuse, no follow-up was required. A chest x-ray dated in July 2010 revealed that the lungs were expanded and clear bilaterally. There were no focal consolidations or pleural effusions, and osseous structures were intact. A chest x-ray dated in November 2010 did not reveal any acute cardiopulmonary disease. In a private treatment record dated in February 2011, the Veteran denied chronic obstructive pulmonary disease, cough, wheezing, or hemoptysis. On examination, his lungs were clear to auscultation, with no crackles, wheezes or egophony. In March 2015, the Veteran's treating physician performed a pulmonary function test; the impression was essentially normal. The physician noted that the Veteran's expiratory reserve volume was reduced, which was probably secondary to his body weight and chest wall/diaphragmatic restriction. The Board observes that the record includes conflicting medical opinions as to whether the Veteran's respiratory disability is related to his active duty service. In a November 2008 submission, Dr. S. noted that the Veteran had a chest roentgen which showed atelectasis and scarring. Dr. S. indicated that this presentation was of undetermined etiology, but "may represent exposure to chemicals or infection." However, the Board notes that Dr. S. did not list a specific respiratory diagnosis related to the atelectasis and scarring. Moreover, his opinion is speculative, at best, as it is vague and does not describe what types of chemicals may have led to the atelectasis and scarring, and it suggests that an infection may have also caused the scarring. Pursuant to the Board's May 2015 remand, the Veteran was afforded a VA examination in August 2015. The examiner noted diagnoses of wheezing and exertional dyspnea in 2007. The Veteran reported being diagnosed with scarring of his lungs on chest x-ray by his primary care physician. The examiner noted that the Veteran had a history of wheezing, but denied a history of pneumonia. The Veteran also denied a history of cigarette smoking. He reported exposure to asbestos while serving on a ship in the Navy. He noted that he was not exposed to asbestos or chemicals in his post-service occupation in the General Motors automobile plant. After a review of the entire medical record, the examiner found that the Veteran's respiratory disability was less likely than not incurred in or caused by service. The examiner noted a diagnosis of wheezing. She explained that a specific trigger for the onset of the wheezing was not identified in the medical records. She explained that the wheezing may have been associated with a respiratory infection. The examiner indicated that a repeat chest x-ray dated in March 2015 did not show evidence of scarring. She noted that the chest x-ray was read as showing some hyperinflation compatible with chronic obstructive pulmonary disease. The examiner noted that a chest CT dated in February 2009 did not reveal any evidence for prior asbestos exposure, asbestosis, or interstitial lung disease. The examiner noted that the recent chest x-ray dated in March 2015 did not show any evidence of interstitial lung disease, pleural plaques, or pleural effusion, all of which would be findings on chest x-ray associated with past asbestos exposure or asbestos-related disease. The examiner explained that the previous scarring noted by Dr. S. may have been due to a previous respiratory infection, but it was no longer present. She noted that exposure to herbicides, to include Agent Orange, has not been associated with respiratory disease. The examiner indicated that current pulmonary function testing showed mild obstruction with a decrease in FEV-1 and an increase in residual volume. She noted that lung volumes and DLCO were reduced. The examiner noted that the pulmonologist found that the DLCO may have been underestimated due to poor inspiratory effort and overall the findings may have been suggestive of extrapulmonary restrictive process like obesity. It is the responsibility of the Board to weigh the evidence, including the medical evidence, and determine where to give credit and where to withhold the same and, in so doing, the Board may accept one medical opinion and reject others. Evans v. West, 12 Vet. App. 22, 30 (1998), citing Owens v. Brown, 7 Vet. App. 429, 433 (1995). But, the Board is mindful that it cannot make its own independent medical determinations, and that there must have plausible reasons, based upon medical evidence in the record, for favoring one medical opinion over another. Evans v. West, supra; see also Rucker v. Brown, 10 Vet. App. 67, 74 (1997), citing Colvin v. Derwinski, 1 Vet. App. 171 (1991). Thus, the weight to be accorded the various items of evidence in this case must be determined by the quality of the evidence, and not necessarily by its quantity or source. In this regard, the Board finds the August 2015 opinion from the VA examiner more probative than the private opinion offered by Dr. S. The Board affords Dr. S.'s opinion little probative weight, as it is speculative and lacks an adequate rationale. Dr. S. did not factually establish or explain the sequence of medical causation using the facts applicable in the Veteran's case. Moreover, his opinion suggests that an infection may have also caused the scarring. Finally, Dr. S. did not list a specific respiratory diagnosis related to the atelectasis and scarring. Such speculation is not legally sufficient to establish service connection. See Stegman v. Derwinski, 3 Vet. App. 228, 230 (1992); Tirpak v. Derwinski, 2 Vet. App. 609, 611 (1992). On the other hand, the Board believes that the August 2015 VA examiner provided sound reasoning in her analysis and affords significant probative value to this opinion. The August 2015 examiner provided a thorough and comprehensive rationale in support of her conclusion that was based on review of the Veteran's entire claims file and medical records (including his lay contentions). The Board finds that the August 2015 examiner's opinion adequately explains why a respiratory disorder, diagnosed as wheezing and exertional dyspnea, was not related to his service, to include exposure to asbestos or Agent Orange. In this regard, the August 2015 examiner explained that a specific trigger for the onset of the Veteran's wheezing was not identified in the medical records, but it may have been associated with a respiratory infection. She noted that the scarring noted by Dr. S. may have been due to a previous respiratory infection, but it was no longer present. She noted that the recent chest x-ray dated in March 2015 did not show any evidence of interstitial lung disease, pleural plaques, or pleural effusion, all of which would be findings on chest x-ray associated with past asbestos exposure of asbestos-related disease. She noted that exposure to herbicides, to include Agent Orange, has not been associated with respiratory disease. The August 2015 examiner found that the current pulmonary function testing findings of reduced lung volumes and DLCO may have been underestimated due to poor inspiratory effort and overall, may have been suggestive of extrapulmonary restrictive process like obesity. The Board attaches the most significant probative value to the August 2015 VA examiner's opinion as it is well reasoned, detailed, consistent with other evidence of record, and included a discussion of the medical evidence of record. Thus, the private opinion of Dr. S. is accorded less weight than that of the VA examiner in August 2015. Accordingly, the Board finds that the preponderance of the evidence of record is against the claim for service connection for a respiratory disorder, diagnosed as wheezing and exertional dyspnea, to include as due to exposure to asbestos or Agent Orange. With respect to the Veteran's assertions, the Board must weigh the credibility and probative value of the evidence. In general, lay witnesses are competent to testify as to their observations as well as opine on questions of diagnosis and etiology in some circumstances. See Buchanan v. Nicholson, 451 F.3d 1331, 1336 (Fed. Cir. 2006) (lay witnesses are competent to testify as to their observations, but this testimony must be weighed against the other evidence of record); Barr v. Nicholson, 21 Vet. App. 303 (2007) (lay testimony is competent to establish the presence of observable symptomatology, where the determination is not medical in nature and is capable of lay observation). See also Davidson v. Shinseki, 581 F.3d 1313, 1316 (Fed. Cir. 2009) (Board's categorical statement that "a valid medical opinion" was required to establish nexus, and that a layperson was "not competent" to provide testimony as to nexus because she was a layperson, conflicts with Jandreau; lay witnesses may, in some circumstances, opine on questions of diagnosis and etiology). The Board has carefully considered the Veteran's lay assertions. The Board acknowledges that a layman is competent to report what he or she experiences through one of the senses. See Layno v. Brown, 6 Vet. App 465, 470 (1994). The Veteran is competent to report respiratory symptoms; however, he is not competent to provide such a complicated opinion assessing the causation of a particular kind of respiratory disorder based on chemical exposures. As the Veteran's statements regarding the etiology of his respiratory disorder are not competent, the issue of credibility on this particular matter is not reached. Moreover, the Board finds the opinion of the VA examiner in the August 2015 VA opinion statement to be more probative. The VA examiner is a medical professional who has reviewed the claims file and considered the Veteran's assertions. The examiner used her expertise in reviewing the facts of this case and determined that the Veteran's respiratory disorder was unrelated to the Veteran's service, to include asbestos or Agent Orange exposure. In light of the foregoing, the Board affords significantly more weight to the fully explained conclusions of the August 2015 VA examiner, which were based on a review of the claims file and the Veteran's contentions. Based on the foregoing discussion, the Board finds that the Veteran's claim must be denied. The weight of the medical evidence is against a finding that the Veteran has a respiratory disorder that is related to his active duty service, to include exposure to asbestos or herbicides. The preponderance of the objective medical evidence of record is against the claim. Therefore, the benefit of the doubt doctrine is not for application herein, and the claim must be denied. 38 U.S.C.A. § 5107(b) (West 2014); Gilbert v. Derwinski, 1 Vet. App. 49 (1990). V. Squamous Cell Carcinoma The Veteran has claimed entitlement to service connection for skin cancer, diagnosed as squamous cell carcinoma, due to either Agent Orange exposure or sun exposure in Vietnam. The Veteran had in-country service in Vietnam; therefore, herbicide exposure is conceded. The crucial inquiry, therefore, is whether the Veteran's squamous cell carcinoma, diagnosed in 1991, was caused by or otherwise related to herbicide exposure or sun exposure in Vietnam, or any other incident of service. Based on the preponderance of the evidence of record, the Board concludes it was not. The Veteran's diagnosed squamous cell carcinoma is not related to his herbicide exposure during service. Squamous cell carcinoma is not on the list of diseases that VA has associated with Agent Orange exposure. The scientific studies reviewed as part of that regulatory process have associated certain cancers and skin diseases with herbicide exposure, but not squamous cell carcinoma. Moreover, the evidence does not link the onset of the squamous cell carcinoma to the Veteran's period of active service, to include sun exposure in Vietnam. The Veteran's service treatment records are silent for a diagnosis of squamous cell carcinoma. There were no skin treatments related to sunburn or sun exposure in service. In his examination upon separation from service dated in July 1967, the Veteran's skin was evaluated as normal. The first diagnosis of squamous cell carcinoma in the record was dated in 1991. The Board acknowledges that in his February 2015 Video conference hearing, the Veteran testified that he was first diagnosed with skin cancer in the 1970's by Dr. R. Although there are records from Dr. R. dating back to the 1990's, there are no records dated in the 1970's. In July 2015, the RO requested that the Veteran provide the names and addresses of any and all health care providers who have provided treatment for his claimed disabilities, to include authorization to obtain medical records from Dr. R. related to his skin cancer. The Veteran did not respond to the RO's request. Notably; however, in his August 2015 VA examination, the Veteran reported that that he was diagnosed with squamous cell carcinoma in 1991. Pursuant to the Board's May 2015 remand, the Veteran was afforded a VA examination in August 2015. The August 2015 VA examiner noted a diagnosis of squamous cell carcinoma in 1991; the lesions were located on the right forearm and temples. The examiner noted that the lesions were removed by a dermatologist, and have reoccurred at the same site and different sites. The examiner noted that the Veteran was exposed to Agent Orange in Vietnam. The examiner found that the Veteran's squamous cell carcinoma was less likely than not incurred in or caused by service. The examiner explained that documented risk factors for squamous cell skin cancer include genetics (fair skin) and cumulative exposure to sunlight and age. The examiner noted that long-term sun light (UV light) increases the risk for skin cancer. The examiner noted that the Veteran's sun exposure while in Vietnam was only for the period of time of his tour of duty. The examiner noted that during his tour of duty, the Veteran was stationed on a ship. The examiner explained that sun damage to the skin is cumulative over time and skin cancer results from long-term exposure over years. The examiner found that the short period of sun exposure in Vietnam would not have caused the Veteran's skin cancer. The Board affords significant probative value to the August 2015 examiner's opinion. The August 2015 examiner provided a thorough and comprehensive rationale in support of her conclusion that was based on review of the Veteran's entire claims file and medical records (including his lay contentions). The Board finds that the August 2015 examiner's opinion adequately explains why the Veteran's squamous cell carcinoma was not related to his service, to include exposure to Agent Orange or the sun while serving in Vietnam. Moreover, this opinion stands uncontradicted by any other evidence of record. Despite the Veteran's contentions that his squamous cell carcinoma is due to either Agent Orange or sun exposure, he is not competent to provide such a complicated opinion assessing the causation of a particular kind of skin cancer based on chemical or sun exposures. No other competent and probative opinion suggests a relationship, or nexus, between the claimed squamous cell carcinoma and the Veteran's active service. In the August 2015 VA opinion, the examiner explicitly stated that squamous cell carcinoma was unrelated to Agent Orange exposure, explaining that squamous cell skin cancer is not one of the diseases that has been associated with Agent Orange exposure. Moreover, the August 2015 examiner found that the short period of sun exposure in Vietnam would not have caused the Veteran's skin cancer, explaining that sun damage to the skin is cumulative over time and skin cancer results from long-term exposure over years. Neither the Veteran nor his representative has identified, presented, or alluded to the existence of any medical evidence or opinion to contradict that provided by the VA examiner (which was based on a review of the medical records). The only evidence of record supporting the Veteran's claim is his general lay assertions. In this case, the Board finds that the Veteran is competent to state that he has experienced skin lesions. See Jandreau v. Nicholson, 492 F.3d 1372, 1376-77 (Fed. Cir. 2007). However, the Veteran is not competent to provide such a complex medical opinion that goes beyond the knowledge of a lay person. Moreover, the Board finds the opinion of the VA examiner in the August 2015 VA opinion statement to be more probative. The VA examiner is a medical professional who has reviewed the claims file and considered the Veteran's assertions. The examiner used her expertise in reviewing the facts of this case and determined that squamous cell carcinoma was unrelated to the Veteran's service, to include Agent Orange or sun exposure in Vietnam. In light of the foregoing, the Board affords significantly more weight to the fully explained conclusions of the August 2015 VA examiner, which were based on a review of the claims file and the Veteran's contentions. Upon review of the foregoing evidence, the Board concludes that the preponderance of the evidence is against finding that the Veteran's squamous cell carcinoma was caused by or otherwise related to service, to include in-service exposure to herbicides or the sun. As such, the benefit of the doubt doctrine is not for application. See generally Gilbert v. Derwinski, 1 Vet. App. 49 (1990); Ortiz v. Principi, 274 F.3d 1361 (Fed Cir. 2001). The appeal must therefore be denied. ORDER Entitlement to service connection for a respiratory disorder is denied. Entitilement to service connection for squamous cell carcinoma is denied. ____________________________________________ MICHAEL LANE Veterans Law Judge, Board of Veterans' Appeals Department of Veterans Affairs