Citation Nr: 18143448 Decision Date: 10/23/18 Archive Date: 10/19/18 DOCKET NO. 16-16 058 DATE: October 23, 2018 ORDER 1. Entitlement to service connection for ischemic heart disease (IHD) is granted. 2. Entitlement to service connection for prostate cancer is granted. 3. Entitlement to service connection for bilateral hearing loss is denied. 4. Entitlement to service connection for tinnitus is denied. 5. Entitlement to service connection for bladder cancer to include as due to exposure to herbicide agents is denied. 6. Entitlement to service connection for ureter reconstruction due to bladder cancer to include as secondary to bladder cancer is denied. 7. Entitlement to right leg popliteal artery occlusion to include as due to exposure to herbicide agents is denied. 8. Entitlement to service connection for lymph gland removal to include as due to exposure to herbicide agents is denied. 9. Entitlement to service connection for right lower extremity peripheral neuropathy to include as due to exposure to herbicide agents is denied. 10. Entitlement to service connection for left lower extremity peripheral neuropathy to include as due to exposure to herbicide agents is denied. 11. Entitlement to service connection for soft tissue carcinoma with skin cancer to include as due to exposure to herbicide agents is denied. 12. Entitlement to service connection for right upper extremity peripheral neuropathy to include as due to exposure to herbicide agents is denied. 13. Entitlement to service connection for left upper extremity peripheral neuropathy to include as due to exposure to herbicide agents is denied. FINDINGS OF FACT 1. It is reasonably shown that the Veteran was exposed to herbicides while serving in Korea from November 1968 to January 1970. 2. The Veteran has a diagnosis of ischemic heart disease. 3. The Veteran has a diagnosis of prostate cancer. 4. A hearing loss disability was not manifested in service; sensorineural hearing loss (SNHL) was not manifested in the first postservice year; and the Veteran’s current bilateral hearing loss is not shown to be etiologically related to his service. 5. Tinnitus is not shown to have been manifested during service or within one year the Veteran’s separation from service, and is not otherwise shown to be etiologically related to his service. 6. Bladder cancer was not manifested in service or within the following year, and the preponderance of the evidence is against a finding that the Veteran’s bladder cancer is related to his service. 7. Postservice ureter reconstruction and lymph gland removal were due to bladder cancer, and not to a service-connected disability. 8. Right leg popliteal artery occlusion was not manifested in, and is not shown to be etiologically related to, the Veteran’s service. 9. The Veteran’s right and left lower extremity peripheral neuropathy was not manifested in service or within a year following his last exposure to herbicides, or a year following his discharge from active duty, and the preponderance of the evidence is against a finding that it is etiologically related to his service. 10. The Veteran is not shown to have soft tissue carcinoma with skin cancer. 11. The Veteran is not shown to have right or upper extremity peripheral neuropathy. CONCLUSIONS OF LAW 1. Service connection for ischemic heart disease is warranted. 38 U.S.C. §§ 1110, 1116, 5107; 38 C.F.R. §§ 3.102, 3.307, 3.309. 2. Service connection for prostate cancer is warranted. 38 U.S.C. §§ 1110, 1116, 5107; 38 C.F.R. §§ 3.102, 3.307, 3.309. 3. Service connection for bilateral hearing loss is not warranted. 38 U.S.C. §§ 1110, 1112, 5107; 38 C.F.R. §§ 3.303, 3.304, 3.307, 3.309. 4. Service connection for tinnitus is not warranted. 38 U.S.C. §§ 1110, 1112, 5107; 38 C.F.R. §§ 3.303, 3.304, 3.307, 3.309. 5. Service connection for bladder cancer and for ureter reconstruction due to bladder cancer is not warranted. 38 U.S.C. §§ 1110, 1112, 1116, 5107; 38 C.F.R. §§ 3.303, 3.304, 3.307, 3.309, 3.310. 6. Service connection for lymph gland removal is not warranted. 38 U.S.C. §§ 1110, 1116, 5107; 38 C.F.R. §§ 3.303, 3.304, 3.307, 3.309, 3.310. 7. Service connection for right popliteal artery occlusion is not warranted. 38 U.S.C. §§ 1110, 1116, 5107; 38 C.F.R. §§ 3.303, 3.304, 3.307, 3.309. 8. Service connection for right and left lower extremity peripheral neuropathy is not warranted. 38 U.S.C. §§ 1110, 1112, 1116, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.304, 3.307, 3.309. 9. Service connection for soft tissue carcinoma with skin cancer is not warranted. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.304. 10. Service connection for right and left upper extremity peripheral neuropathy is not warranted. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.304. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The appellant is a Veteran who served on active duty from May 1968 to January 1970. This matter is before the Board of Veterans’ Appeals (Board) on appeal from December 2014 and March 2015 rating decisions. The Agency of Original Jurisdiction (AOJ) did not arrange for VA examinations regarding the matters of service connection for bladder cancer, ureter reconstruction, right leg popliteal artery occlusion, lymph gland removal, skin cancer, and right and left lower and upper extremity peripheral neuropathy. As will be further explained below, such examinations are not needed because the record does not contain any competent evidence suggesting there may be a link between such disabilities and the Veteran's active duty service. See 38 C.F.R. § 3.159 (c)(4); McLendon v. Nicholson, 20 Vet. App. 27 (2006). Service connection may be granted for disability due to disease or injury incurred in or aggravated by active military service. 38 U.S.C. § 1110; 38 C.F.R. § 3.303. Service connection may be granted for any disease initially diagnosed after discharge, when all the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303 (d); Combee v. Brown, 34 F.3d 1039 (Fed. Cir. 1994). To substantiate a claim of service connection, there must be evidence of: a present disability (for which service connection is sought); incurrence or aggravation of a disease or injury in service; and a causal relationship between the claimed disability and the disease or injury incurred or aggravated during service. Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004). Certain chronic diseases (to include SNHL and tinnitus as organic diseases of the nervous system, and malignant tumors) may be service-connected on a presumptive basis if manifested to a compensable degree within a specified period following separation from service (one year for those three diseases). 38 U.S.C. § 1112; 38 C.F.R. §§ 3.307, 3.309. For chronic diseases listed in 38 C.F.R. § 3.309(a), nexus to service may be established by showing continuity of symptomatology since service. Walker v. Shinseki, 708 F.3d 1331, 1338-40 (Fed. Cir. 2013). Hearing impairment is considered a disability (for VA compensation purposes) when the auditory threshold in any of the frequencies 500, 1000, 2000, 3000, 4000 Hertz (Hz) is 40 decibels (dB) or greater; or when the auditory thresholds for at least three of the frequencies 500, 1000, 2000, 3000, or 4000 Hz are 26 dB or greater; or when speech recognition scores using the Maryland CNC Test are less than 94 percent. 38 C.F.R. § 3.385. A Veteran who, during military service, served in the Republic of Vietnam during the Vietnam era (beginning in January 1962 and ending in May 1975) shall be presumed to have been exposed during such service to certain herbicide agents, including an herbicide commonly referred to as Agent Orange. 38 U.S.C. § 1116 (f); 38 C.F.R. § 3.307(a)(6)(iii). The Department of Defense (DoD) has determined that herbicide (including Agent Orange) was used along the Korean DMZ from April 1, 1968, to August 31, 1971. Veterans assigned to one of the units listed as being at or near the Korean DMZ during that time period are also presumed to have been exposed to herbicide agents. 38 U.S.C. § 1116; 38 C.F.R. § 3.307 (a)(6)(iv). If a Veteran was exposed to an herbicide agent (to include Agent Orange) during active service and has contracted an enumerated disease (to include ischemic heart disease, prostate cancer, and early onset peripheral neuropathy), the Veteran is entitled to a presumption of service connection for such disease even though there is no record of such disease during service. 38 U.S.C. § 1116; 38 C.F.R. §§ 3.307, 3.309(e). The presumptive provisions of 38 U.S.C. § 1116 have been extended to encompass Veterans shown to have been otherwise exposed to tactical herbicides in service, including while serving in Thailand, or on the DMZ in Korea. When a claimed disorder is not included as a presumptive disorder under 38 C.F.R. § 3.309(e), direct service connection may nonetheless be established by evidence demonstrating that the disease was in fact “incurred” during service. See Combee v. Brown, 34 F.3d 1039, 1042 (Fed. Cir. 1994). 1., 2. Service connection for ischemic heart disease (IHD) and prostate cancer is granted. The Veteran’s service personnel records note that the was stationed at Camp Page, Korea from November 1968 to January 1970. His service treatment records (STRs) are silent for complaint, treatment, or diagnosis, of IHD and prostate cancer. An October 2013 VA treatment record notes that in 2012 a cystectomy and prostatectomy were performed for the Veteran’s stage IV cancers of the bladder and the prostate. Also noted was very significant cardiovascular disease including myocardial infarction, coronary artery stents, aortofemoral bypasses, and coronary artery disease. In an October 2013 buddy statement, R.P. advised that the Veteran was in his section at Camp Page, served as an Honest John Rocket crewman, and made several trips to the DMZ. In an October 2013 statement the Veteran reported that he was embedded with the 2nd Infantry Division and White Horse Division (South Korean). He related that he was in the field on military assignments with 2nd Infantry Division on several occasions (7 months total) for training and fire missions. They camped for several weeks in the field, bathed in the streams, and slept on the ground. A January 2014 VA treatment record notes the Veteran’s cancers of the bladder, ureter, and prostate with lymph node metastasis. A September 2014 VA treatment record notes a malignant prostate tumor, right leg popliteal artery occlusion, urothelial carcinoma, and idiopathic peripheral neuropathy of the lower extremities. A September 2014 Formal finding on lack of information required to verify Agent Orange exposure at Camp Page, Korea, notes that in an October 2013 statement the Veteran indicated that he was exposed to herbicides. In September 2014 a response from the Joint Services Records Research Center (JSRRC) indicated that the Veteran was not exposed to Agent Orange because the presumption of exposure to Agent Orange does not include units assigned to Camp Page, Korea. A September 2014 response from the Defense Personnel Records Information Retrieval System (DRIS) notes a review of the 1969 unit histories submitted by the 1st Battalion (Honest-John), 42nd Artillery and their higher headquarters, the 4th US Army Missile Command. The histories document that the 1st Battalion, 42nd Artillery was located at Camp Page, South Korea, approximately six miles from the Demilitarized Zone (DMZ). The histories also document that the 1st Battalion, 42nd Artillery conducted field training and live fires. However, the histories do not document the use, storage, spraying or transportation of herbicides. In addition, the histories do not document any specific duties performed by members of the 1st Battalion, 42nd Artillery along the DMZ. The search was also coordinated with the National Archives and Records Administration (NARA) in College Park, Maryland. Due to the lack of unit records available, DPRIS was unable to document the use, storage, spraying, or transportation of herbicides or any specific duties performed by the Veteran or members of his unit along the DMZ. In August 2015, the Veteran submitted additional buddy statements from R.P. and R.N. R.P.’s statement notes that he and the Veteran made several trips south of the DMZ. R.N. noted that he and the Veteran made several trips to the DMZ to work on rocket launchers. As the claims of service connection for IHD and prostate cancer are premised on the theory that they are due to exposure to Agent Orange, the threshold question that must be resolved is whether the Veteran was indeed exposed to Agent Orange in service. He did not serve in Vietnam, but the Agent Orange presumption has been extended to Veterans who served along the Korean DMZ from April 1, 1968, to August 31, 1971. Official attempts at verification of the Veteran’s allegations of exposure to Agent Orange in the Korean DMZ resulted in negative responses based on findings that the presumption of exposure does not extend to those stationed at Camp Page, and that the unit records do not show that the Veteran’s unit (or its members) conducted activities near the DMZ. Acknowledging that the presumption of exposure does not extend to Camp Page, and that unit histories do not place the Veteran’s unit (or its members) in the DMZ, the Veteran is nonetheless faced with assessing the credibility of the Veteran’s allegations that his details (while stationed at Camp Page) placed him in or near the DMZ. Unit histories would not necessarily have included details of all unit activities. The Veteran has submitted corroborating statements (to include from a supervising Sergeant) indicating that his details placed him at/in the DMZ. Considering the proximity of Camp Page to the DMZ and the detailed accounts of his assigned duties (corroborated by supporting statements the Board has no reason to find not credible), the Board finds that it reasonably shown that the Veteran’s duties in service placed him in the Korean DMZ when Agent Orange was known to have been used there, and that the evidence is at least in equipoise regarding whether he was exposed to Agent Orange/herbicide agents in service. The record shows that he has diagnoses of IHD and prostate cancer. Based on the finding above, he is entitled to consideration of these claims under the presumptive provisions of 38 U.S.C. § 1116. The requirements for establishing service connection based on exposure to herbicide agents are met; service connection for IHD and prostate cancer is warranted. 3. Service connection for bilateral hearing loss is denied. The Veteran served as an artilleryman during service. His STRs contain no mention of complaints, diagnosis or treatment pertaining to hearing loss. His ears were normal on service separation examination. On February 1968 service entrance examination, audiometry showed that puretone thresholds in decibels were: 500 1000 2000 3000 4000 R -5 (10) -10 (0) -10 (0) -10 (0) -5 (0) L 0 (15) -5 (5) -5 (5) 5 (5) 0 (5) [Numbers in parentheses represent conversions of findings reported in ASA values to the ISO values now in use. On November 1969 service separation examination audiometry, puretone thresholds were: 500 1000 2000 3000 4000 R 20 10 5 5 5 L 10 5 5 25 10 On November 2014 VA audiological examination audiometry, puretone thresholds were: 500 1000 2000 3000 4000 R 15 15 60 60 60 L 25 15 75 80 80 Speech audiometry revealed speech recognition ability of 74 percent in the right ear and 66 percent in the left. The examiner noted that on November 1969 service separation examination, audiometry showed normal hearing bilaterally. The Veteran reported that he drove a cement truck and worked construction for forty years after service and seldom used hearing protection during that time. He reported that during service he was exposed to noise from rocket and missile artillery, and small arms fire on the range. The examiner opined that military noise exposure was not responsible for the Veteran’s hearing loss, and that the majority of the Veteran’s hearing loss is more likely than not the result of forty years of working in construction with partial hearing protection use. The record does not include any further medical opinions regarding the etiology of the Veteran’s hearing loss. It is not in dispute that the Veteran has a hearing loss disability. He served as an artilleryman, and the Board finds it reasonably shown that he was subjected to noise trauma in service. What remains necessary to substantiate this claim is competent evidence that the current hearing loss disability is related to his service/noise trauma therein. See Shedden v. Principi, 381 F. 3d 1163, 1167 (Fed. Cir. 2004). SNHL was not manifested in service or in the first year following the Veteran’s discharge from active duty, and service connection for such disability on the basis that it became manifest in service and persisted, or on a chronic disease presumptive basis (under 38 U.S.C. § 1112; 38 C.F.R. § 3,309(a) is not warranted. As SNHL (as an organic disease of the nervous system) is listed as a chronic disease in 38 C.F.R. § 3.309 (a), for consideration is whether service connection for this disability may be established by finding continuity of symptomatology. Continuity of symptomatology of hearing loss disability is not demonstrated by the evidence in the record. The Veteran did not report a hearing loss on November 1969 separation examination. He is not competent to establish continuity of a SNHL disability by his own recollections of remote events; hearing loss disability is defined by governing regulation and must be demonstrated by specified testing. See 38 C.F.R. §§ 3.385, 4.85. There is no documentation in the record of hearing loss disability established by the specified testing until decades after service (in November 2014). Such evidence weighs heavily against a finding of continuity. The Board finds that continuity of hearing loss symptomatology is not shown. Therefore, service connection for bilateral hearing loss based on continuity of symptomatology is not warranted. Service connection for a hearing loss disability may still be established by competent evidence that the hearing loss, first documented many years after service is etiologically related to service. See Hensley v. Brown, 5 Vet. App. 155, 159 (1993). The Veteran has presented no such evidence. Whether a current hearing loss disability may, in the absence of evidence of onset in service and continuity thereafter, be related to remote service/exposure to noise trauma therein is a medical question. The Veteran is a layperson, and his own opinion in the matter is not competent evidence; he does not cite to supporting medical opinion, text, or treatise. The only competent (medical) evidence in the record regarding a nexus between the Veteran’s current hearing loss and his service is in the opinion of the November 2014 VA examiner who opined that the Veteran’s hearing loss disability is unrelated to his service/noise trauma therein. The examiner is a medical professional competent to offer the opinion, and the opinion reflects familiarity with the Veteran’s medical history, and is supported by rationale that cites to accurate factual data, including the absence of related complaints or findings during service, and that noise exposure from forty years of working in construction with only partial hearing protection use is a more likely etiology. The opinion is probative evidence in this matter, and without competent evidence to the contrary is persuasive. The preponderance of the evidence is against this claim, and the appeal seeking service connection for bilateral hearing loss must be denied. 4. Service connection for tinnitus is denied. The Veteran’s service treatment records (STRs) are silent for complaint, treatment, or diagnosis, of tinnitus. An October 2013 VA treatment record notes that the Veteran denied having tinnitus or ringing in the ears. An August 2014 VA audiological consult notes that the Veteran reported that he did not have tinnitus. On November 2014 VA audiological examination, the Veteran reported that he had tinnitus and that it began around 1980. He related that his ears ring approximately once per month and that the ringing persists until he blows his nose or performs the Valsalva maneuver. The examiner opined that it was less likely than not that the tinnitus was related to the Veteran’s hearing loss or as the result of noise exposure. He explained that since the tinnitus can generally be relieved with pressure on the tympanic membrane, either from performing a Valsalva-like maneuver or by applying physical pressure with his hands to his ears, this implies that the tinnitus is likely due to the middle ear and not hazardous noise exposure. It is not in dispute that the Veteran now has tinnitus; the diagnoses is established based on self-reports by the person experiencing it. What the Veteran must show to substantiate this claim is that the tinnitus is etiologically related to his service, to include as due to exposure to hazardous level noise therein. There is no evidence that the tinnitus manifested in service or in the first postservice year. October 2013 and August 2014 VA treatment records note that the Veteran denied having tinnitus, and on November 2014 audiological evaluation, he reported that the tinnitus had been manifested since 1980 (approximately 10 years after his discharge from service). Consequently, service connection for tinnitus on the basis that it became manifest in service and persisted, on a presumptive basis (as a chronic disease under 38 U.S.C. § 1112), or based on continuity (under 38 C.F.R. § 3.303(b)) is not warranted. What remains for consideration is whether the Veteran’s tinnitus is otherwise shown to be etiologically related to his service. Whether a current tinnitus may be related to remote service/events, to include exposure to noise therein, is a medical question beyond the realm of common knowledge, and incapable of resolution by lay observation (other than by observation of continuity of complaints, which the Board has found is not shown). See Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007). The only medical evidence in the record that directly addresses the matter of a nexus between the Veteran’s hearing loss and tinnitus and his service is in the reports of the VA examination and opinion discussed above. The Board finds that the opinion offered on November 2014 VA examination report is entitled to substantial probative weight. The examiner reviewed the Veteran’s medical history and included adequate rationale for the conclusion reached, citing to accurate factual data and medical principles. The Veteran has not submitted any medical opinion to the contrary. His lay assertions that his tinnitus is related to service are not competent evidence in this matter. Laypersons are competent to provide opinions on some medical issues. However, as was noted, without evidence of continuity, etiology of tinnitus is a matter outside the realm of common knowledge of a layperson. See Kahana v. Shinseki, 24 Vet. App. 428 (2011). He does not cite to supporting medical opinion or medical literature evidence. The preponderance of the evidence is against this claim. Accordingly, the appeal in this matter must be denied. 5., 6., 7., 8., 9., 10. Service connection for bladder cancer with ureter reconstruction and lymph gland removal, right leg popliteal artery occlusion, and right and left lower extremity peripheral neuropathy, to include as due to exposure to herbicide agents, is denied. The Veteran claims that his currently diagnosed bladder cancer, ureter reconstruction, lymph gland removal, right leg popliteal artery occlusion, and right and left lower extremity peripheral neuropathy are all due to exposure to herbicide agents in service The Veteran’s service treatment records (STRs) are silent any complaint, treatment, or diagnosis, of bladder cancer, right popliteal artery occlusion, and right and left lower extremity peripheral neuropathy, and his ureter reconstruction and lymph gland removal occurred decades after service. An October 2013 VA treatment record notes various surgical procedures, including a 2012 cystectomy for the Veteran’s state IV bladder cancer. An external iliac lymph node and his ureter were positive for metastatic disease. A January 2014 VA treatment record notes cancers of the bladder, ureter, and prostate with lymph node metastasis. A September 2014 VA treatment record notes a right leg popliteal artery occlusion, urothelial carcinoma, and idiopathic peripheral neuropathy of the lower extremities. It is not in dispute that the Veteran now has bladder cancer, with related ureter reconstruction and lymph gland removal, right popliteal artery occlusion, and peripheral neuropathy of both lower extremities. As found above, it is also established that he was exposed to Agent Orange/herbicide agents in service. The critical question remaining is whether there is competent evidence of a nexus between his service (and exposure to herbicide agents) and these claimed disabilities. There is no evidence, or allegation, that the Veteran’s peripheral neuropathy was manifested within a year following his last presumed exposure to herbicides in service in 1970. Peripheral neuropathy of the lower extremities was not diagnosed until 2014, more than 30 years after he is presumed to have last been exposed to Agent Orange and some 34 years after his separation from service. Consequently, service connection for peripheral neuropathy on the basis that it became manifest in service and persisted or on a presumptive basis (either as a chronic disease under 38 U.S.C. § 1112; 38 C.F.R. § 3.309(a), or, as early onset peripheral neuropathy. based on exposure to herbicide agents under 38 U.S.C. § 1116; 38 C.F.R. § 3.309(e)) is not warranted. Bladder cancer (with ureter reconstruction and lymph gland removal) and popliteal artery occlusion are not listed in 38 C.F.R. § 3.309(e); therefore, the presumptive provisions under 38 U.S.C. § 1116 do not apply. While the Veteran may still establish service connection for bladder cancer, with ureter reconstruction and lymph gland removal, right popliteal artery occlusion, and peripheral neuropathy of both lower extremities by affirmative evidence showing such disabilities are etiologically related to his service/environmental exposures therein, (under 38 C.F.R.§ 3.303 (d)), he has presented no such evidence. In the absence of entitlement under potentially applicable presumptions under 38 U.S.C. §§ 1112, 1116) and showing of continuity of symptoms, whether disabilities such as bladder cancer with ureter reconstruction and lymph gland removal, right popliteal artery occlusion, and peripheral neuropathy of the lower extremities are related to remote service/an event therein is a medical question. The Veteran has not presented any medical literature or medical opinion in support of these claims. Because bladder cancer is determined to not be service-connected, the secondary service connection theory of entitlement for ureter reconstruction and lymph gland removal (as secondary to bladder cancer) lack legal merit. The preponderance of the evidence is against these claims. Hence, the benefit of the doubt doctrine does not apply; the appeals in these matters must be denied 11., 12., 13. Service connection for soft tissue carcinoma with skin cancer, and right and left upper extremity peripheral neuropathy, each to include as due to exposure to herbicide agents, is denied. The Veteran’s STRs are silent for complaints, treatment, or diagnoses related to soft tissue carcinoma, and right or left upper extremity peripheral neuropathy. The threshold question that must be addressed in these matters (as with any claim seeking service connection) is whether there is competent evidence that the Veteran currently has (or during the pendency of the claim has had) the disability for which service connection is sought (soft tissue carcinoma with skin cancer, and peripheral neuropathy of the right and left upper extremities). In the absence of proof of such current disabilities, these are no valid claims for service connection. See Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992). There is no competent evidence that the Veteran has (or during the pendency of this claim has had) skin cancer or peripheral neuropathy of an upper extremity. His service and postservice treatment records do not show such disabilities. VA treatment records note idiopathic peripheral neuropathy of the lower extremities, only. The Veteran’s treatment records include detailed information regarding the disabilities he has been found to have; presumably if he had these disabilities they would appear among the diagnoses listed in the record. His own reports that he has skin cancer and upper extremity peripheral neuropathy are not competent evidence he has such disabilities. The diagnoses of these disabilities are medical questions that require medical expertise (and he is a layperson, and does not cite to supporting medical opinion or medical literature). See Jandreau v. Nicholson, 492 F. 3d 1372, 1377 (2007). Without competent evidence that the Veteran has soft tissue carcinoma with skin cancer, and right and left upper extremity peripheral neuropathy, there are no valid claims of service connection for such disabilities. See Brammer, 3 Vet. App. at 225. The preponderance of the evidence is against these claims; therefore, the benefit-of-the-doubt doctrine does not apply; the appeals in these matters must be denied. See 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102. GEORGE R. SENYK Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD J. Bayles, Associate Counsel