Citation Nr: 18150305 Decision Date: 11/14/18 Archive Date: 11/14/18 DOCKET NO. 16-37 250 DATE: November 14, 2018 ORDER Entitlement to service connection for a pituitary macroadenoma (also claimed as a pituitary gland tumor) is denied. FINDINFG OF FACT The preponderance of the evidence is against finding that a pituitary macroadenoma was demonstrated during or is related to the Veteran’s active duty service, including due to herbicide agent exposure. CONCLUSION OF LAW A pituitary macroadenoma was not incurred or aggravated in service, and may not be presumed to have been so incurred. 38 U.S.C. §§ 1101, 1110, 1112, 1113, 1116, 5103, 5103A, 5107; 38 C.F.R. §§ 3.159, 3.303, 3.304, 3.307, 3.309. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran had active military service from April 1968 to January 1971. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a May 2015 rating decision by the Department of Veterans Affairs (VA) Regional Office (RO) in Denver, Colorado. The Veteran contends he has a pituitary macroadenoma that is related to his active duty service, to specifically include due to his exposure to herbicides in the Republic of Vietnam. As support the representative has identified several pieces of medical literature pertaining to tumor promotion where a person has been exposed to dioxin. Service connection will be granted for a disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. § 1110. Establishing service connection generally requires (1) medical evidence of a current disability; (2) medical or, in certain circumstances, lay evidence of in-service incurrence or aggravation of a disease or injury; and (3) evidence of a nexus between the claimed in-service disease or injury and the present disability. Shedden v. Principi, 381 F.3d 1163 (Fed. Cir. 2004). Regulations also provide that service connection may be granted for any disease diagnosed after discharge, when all the evidence, including that pertinent to service, establishes that the disability was incurred in service. 38 C.F.R. § 3.303 (d). For certain chronic diseases such as a malignant tumor a presumption of service connection arises if the disease is manifested to a degree of 10 percent within one year following discharge from active duty. 38 C.F.R. §§ 3.307, 3.309. As the Veteran served on the land mass of the Republic of Vietnam he is presumed to have been exposed to Agent Orange and other herbicides while on active duty. 38 C.F.R. § 3.307. While presumptive service connection may be granted for certain diseases associated with in-service exposure to herbicide agents the list of recognized presumptive diseases does not include pituitary macroadenoma. 38 C.F.R. §§ 3.307, 3.309(e). Nevertheless, a claimant is not precluded from establishing service connection with proof of actual direct causation related to exposure to herbicide agents. See Combee v. Brown, 34 F.3d 1039, 1043 (Fed. Cir. 1994). In this case, the Veteran’s service treatment records reveal no complaints, findings or diagnoses of a pituitary macroadenoma. Indeed, the earliest evidence of any indication of a pituitary macroadenoma dates from 2014, i.e., decades after the appellant’s separation from active duty. The lack of medical findings of any diagnosis or treatment of a pituitary macroadenoma for many years after service is probative evidence against the claim. Maxson v. Gober, 230 F.3d 1330, 1333 (Fed. Cir. 2000). The Board further finds that while the appellant has a pituitary macroadenoma, there is no competent evidence linking the disorder to service to include his presumed exposure to herbicides. While the appellant may sincerely believe that his pituitary macroadenoma is related to service, as a lay person untrained in the field of medicine he is not competent to offer a medical opinion linking that disorder to service. See, e.g., Jandreau v. Nicholson, 492 F.3d 1372, 1376-77 (Fed. Cir. 2007). Accordingly, the Board finds that the preponderance of the evidence is against the claim, and that it should be denied. In reaching this decision the Board acknowledges the agent’s references to several medical articles. Medical articles or treatises can provide important support for a claim. Significantly, unless the articles pertain to the specifics of the appellant’s case they must be combined with an opinion by a medical professional showing the articles support a nexus to service. Mattern v. West, 12 Vet. App. 222 (1999); Sacks v. West, 11 Vet. App. 314 (1998); Wallin v. West, 11 Vet. App. 509 (1998). Here the articles submitted by the Veteran are not accompanied by any probative opinion from any medical expert. There is no probative evidence, specific to the facts and medical history presented in this case, that the Veteran’s pituitary tumor is related to service or his inservice exposure to Agent Orange. Thus, the articles lack probative value. Finally, in arriving at this decision, the Board considered the doctrine of reasonable doubt. That doctrine is only invoked, however, where there is an approximate balance of evidence which neither proves nor disproves the claim. In this case, the preponderance of the evidence is against the Veteran’s claim. Therefore, the doctrine of reasonable doubt is not applicable. 38 U.S.C. § 5107 (b); 38 C.F.R. § 3.102. DEREK R. BROWN Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD Anthony L. Hines Associate Attorney