Citation Nr: 18159770 Decision Date: 12/20/18 Archive Date: 12/19/18 DOCKET NO. 16-51 963 DATE: December 20, 2018 ORDER Entitlement to service connection for a sleep disorder is DENIED. Entitlement to service connection for oral cancer is DENIED. FINDINGS OF FACT 1. The evidence establishes that the Veteran’s sleep disturbance is a symptom of his service-connected PTSD and he does not have a separately diagnosed current sleep disorder, including obstructive sleep apnea. 2. The preponderance of the evidence is against a finding that the Veteran’s oral cancer was incurred during active duty in the United States Marine Corps. CONCLUSIONS OF LAW 1. A sleep disorder disability that is separate and distinct from the Veteran’s service-connected PTSD was not incurred in or aggravated by active duty, and is not proximately due to or the result of service-connected disability. 38 U.S.C.A. §§ 1101, 1110, 1131, 1154(b), 5107 (West 2014); 38 C.F.R. §§ 3.303, 3.304, 3.310 (2017). 2. The criteria for entitlement to service connection for oral cancer have not been satisfied. 38 U.S.C. §§ 1101, 1131, 1133, 5103, 5103A, 5107 (West 2014); 38 C.F.R. §§ 3.102, 3.159, 3.303, 3.304, 3.310, 3.317 (2017). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served honorably in the United States Marine Corps from May 1987 to May 1993. The Veteran’s certificate of release from active duty (DD214) reflects that he was recipient of the Southwest Asia Service Medal and Kuwait Liberation Medal. In addition to the issues addressed in this decision, the Veteran also perfected an appeal of the denial of service connection for posttraumatic stress disorder. A rating action was promulgated by the agency of original jurisdiction (AOJ) in June 2018 awarding service connection for PTSD. A 30 percent evaluation for PTSD was provided, effective December 7, 2017. The June 2018 AOJ decision is a full grant of the benefit that had been sought on appeal (entitlement to service connection for PTSD) and satisfies the Veteran’s appeal of that issue. Thus, the issue of entitlement to service connection for PTSD is not before the Board. In other words, there is no longer a question or controversy remaining concerning whether service connection for PTSD is warranted. Should the Veteran disagree with either the initial effective date assigned for his PTSD, or the disability evaluation assigned, he is advised that he has one year from the date that the AOJ notifies him of the award of benefits to file a notice of disagreement. 1. Entitlement to service connection for a sleep disorder is denied. In December 2014, VA received correspondence that was forwarded by United States Senator T. Cochran. Therein, the Veteran posited that, “I’m lucky if I get 4 hours of sleep a night.” To establish entitlement to service connection, there must be evidence of (1) a current disability, (2) incurrence or aggravation of a disease or injury in service, and (3) a nexus between the in-service injury or disease and the current disability. See 38 U.S.C. § 1110; Davidson v. Shinseki, 581 F.3d 1313, 1315-16 (Fed. Cir. 2009); Shedden v. Principi, 381 F.3d 1163, 1166-67 (Fed.Cir.2004); 38 C.F.R. § 3.303. Lay assertions may serve to support a claim for service connection by establishing the occurrence of observable events or the presence of disability or symptoms of disability subject to lay observation. 38 U.S.C.A. § 1153 (a) (West 2014); 38 C.F.R. § 3.303 (a) (2015); Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007); see also Buchanan v. Nicholson, 451 F. 3d 1331, 1336 (Fed. Cir. 2006) (addressing lay evidence as potentially competent to support presence of disability even where not corroborated by contemporaneous medical evidence). The United States Court of Appeals for the Federal Circuit (Federal Circuit) has clarified that lay evidence can be competent and sufficient to establish a diagnosis or etiology when (1) a lay person is competent to identify a medical condition; (2) the lay person is reporting a contemporaneous medical diagnosis, or (3) lay testimony describing symptoms at the time supports a later diagnosis by a medical professional. Davidson v. Shinseki, 581 F.3d 1313 (Fed. Cir. 2009). Service connection may also be granted for any disease diagnosed after discharge, when all of the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303 (d). For purposes of establishing service connection, a “current disability” includes a disability which existed at the time a claim for VA disability compensation is filed or during the pendency of the claim, even if that disability subsequently resolves. McClain v. Nicholson, 21 Vet. App. 319, 321 (2007). The credibility and weight of all the evidence, including the medical evidence, should be assessed to determine its probative value, and the evidence found to be persuasive or unpersuasive should be accounted for, and reasons should be provided for rejecting any evidence favorable to the claimant. See Masors v. Derwinski, 2 Vet. App. 181 (1992). Equal weight is not accorded to each piece of evidence contained in the record; every item of evidence does not have the same probative value. It is the Board’s responsibility to determine whether a preponderance of the evidence supports the claim or whether the evidence is in relative equipoise, with the veteran prevailing in either event, or whether there is a preponderance of evidence against the claim, in which case the claim must be denied. See Gilbert v. Derwinski, 1 Vet. App. 49 (1990). When, after careful consideration of all procurable and assembled data, a reasonable doubt arises regarding service origin, the degree of disability, or any other point, such doubt will be resolved in favor of the claimant. By reasonable doubt is meant one which exists because of an approximate balance of positive and negative evidence which does not satisfactorily prove or disprove the claim. 38 C.F.R. § 3.102. In January 2015, the Veteran’s service treatment records (STRs) were associated with his claims file. After careful and deliberate review, the Board notes that the Veteran’s STRs do not document the in-service incurrence of a sleep disorder. In fact, during his April 1993 separation examination, it was specifically noted that the Veteran did not report sleep-related symptoms. In April 2015, the Veteran underwent a VA examination that addressed PTSD. Relevant to this Board analysis, it was noted that, “Veteran reports frequent nightmares. Veteran reports Zoloft has helped to decrease his nightmares. Veteran reports one nightmare per week now. Veteran reports he has not been able to sleep more than 4-5 hours per night since serving in Somalia.” Under the DSM-5 Criteria E (for PTSD), Dr. MRR noted sleep disturbances (e.g., difficulty falling or staying asleep or restless sleep). Among the Veteran’s four noted symptoms, Dr. MRR reported chronic sleep impairment. In April 2015, a Gulf War General Medical Examination Disability Benefits Questionnaire (DBQ) was generated. After review of the Veteran’s claims file, Dr. TES remarked that, “(t)his Veteran gives no history of illnesses suggestive of a Gulf War syndrome.” Also, Dr. TES remarked that, “(t)he claimed sleep disorder relates to insomnia. See the PTSD DBQ re such.” In June 2015, the Veteran submitted his notice of disagreement (NOD). Therein, the Veteran posited that, “sleep problems have all been a daily & weekly occurrence since I served time in the service, in particular during the times I served in the Persian Gulf & Somalia.” In October 2016, the Veteran submitted his VA Form 9. Therein, the Veteran posited that, “I believe that I should be service connected for my sleep problems. My sleep problems started when I was stationed in the Persian Gulf/Kuwait. I continued to have problems with my sleep when in Somalia. I had problems going to sleep, staying asleep and having a restful night. I had never had problems with my sleep patterns until I was on active duty in the military. During active duty my sleep patterns were irregular. After I was discharged from active duty I have continued to have sleep problems and disturbance. I did not think that much about it at the time because I needed to go on with my life. Now I not only have interrupted sleep patterns but I avoid going to sleep and I will often awake because of nightmares. I normally only got 3 to 4 hours of sleep daily. Family and friend are aware of my problems with sleep. They are very cautious and they know that no one should try to wake me up when I am asleep because of my responses and startled reactions.” In December 2017, the Veteran supplied sworn testimony to a decision review officer DRO. At that time, the Veteran testified that he was having PTSD symptoms during active service. Concerning in-service sleep problems, the Veteran testified that, “I really wasn’t aware I was having sleep problems.” When addressing problems relating to PTSD, the Veteran testified that, “on a good night, I’ll sleep four hours. . . . I can guarantee you I will wake up two-and-a-half or three hours every single night and could not go back to sleep. I’ll have to sit up and I watch TV or walk around my apartment, look out the windows, and do whatever.” The Veteran further testified that, “I have nightmares . . . about four or five times a week all of the time. I wake up in cold sweats.” The Veteran supplied the following testimony about sleep aides: “The only medication I’m taking now is Trazodone and that’s to help me . . . It’s supposed to help me sleep, but all it does is help me fall asleep fast, but I’m still only getting four hours of sleep a night.” The Veteran testified that he first approached a doctor about sleep problems in 1995. In December 2017, the Veteran underwent another VA examination to address his PTSD. In the resultant report, Dr. Young noted a history of difficulty to initiate and stay asleep, average sleep of 3 hours, bad dreams, and night sweats. Among the Veteran’s DSM-5 Criteria E, a sleep disturbance (e.g., difficulty falling or staying asleep or restless sleep) was noted. Among the Veteran’s five noted PTSD symptoms, Dr. Young recorded chronic sleep impairment. In December 2017, VA received a typed statement from the Veteran’s ex-wife, PC. Therein, PC revealed that, “(the Veteran) was showing signs of now what we know as PTSD. . . . He hardly ever went to sleep by not sleeping through the night.” The statement continued with, “(h)e was still showing signs of depression, anxiety and not sleeping.” In December 2017, VA also received a typed statement from the Veteran’s friend, VW. Therein, VW revealed that, “(m)y recent visit was one week long and I stayed in his home. I noticed how he was unable to sleep throughout the night. His apartment was very dark and he refused to open any curtains.” Also, VW relayed that, “(h)is paranoid ways is associated with his day during the war. He has difficulties sleeping and constantly checks windows and doors for possible intruders.” The Board acknowledges and appreciates the various statements from the Veteran, the Veteran’s former spouse, and the Veteran’s friend. The Board notes that while the Veteran is competent to testify about the symptoms he has observed during the course of his claimed disability, he is not competent to identify the etiology for any currently endured sleep symptoms. See Clemons v. Shinseki, 23 Vet. App. 1, 4-5 (2009)(citing Espiritu v. Derwinski, 2 Vet. App. 492, 494-95 (1992)). The first requisite element of a direct service connection claim is not present, because the Veteran does not maintain a curtain diagnosis for a sleep disorder. While the Veteran does have sleep impairment as a result of his PTSD, the evidence does not show that he a separate sleep disorder diagnosis. To the extent that he has trouble with sleep is associated with his PTSD, the disability evaluation currently assigned for his PTSD contemplates such symptomatology. Specifically, the 30 percent currently assigned for PTSD contemplates occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks due to symptoms such as chronic sleep impairment. The record does not show that the Veteran has a diagnosis of a chronic sleep disorder that is not a symptom of his PTSD. The second requisite element is also not present, because the Veteran’s STRs do not contain a notation that would support an in-service incurrence of a sleep disorder. Moreover, the Veteran testified that he first sought medical care for sleep problems in 1995, which is two years after he separated from the United States Marine Corps. Ultimately, the Board concludes that the preponderance of competent evidence within the Veteran’s claims file supports that service-connected PTSD is the source of his difficulty sleeping. The Veteran’s PTSD is rated under the General Rating Formula for Mental Disorders at 38 C.F.R. § 4.130, Diagnostic Code (DC) 9411. Under DC 9411, a 30 percent rating is warranted when there is occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks (although generally functioning satisfactorily, with routine behavior, self-care, and conversation normal), due to such symptoms as: depressed mood, anxiety, suspiciousness, panic attacks (weekly or less often), chronic sleep impairment, mild memory loss (such as forgetting names, directions, recent events). Id. (emphasis added) Thus, the General Rating Formula recognizes that chronic sleep impairment is a symptom of the Veteran's PTSD, and his PTSD is rated accordingly. To grant service connection for a sleep disorder other than a diagnosable disorder such as sleep apnea would amount to nothing more than pyramiding. Pyramiding, the evaluation of the same disability, or the same manifestation of a disability, under different diagnostic codes, is to be avoided when evaluating a veteran’s service-connected disability. 38 C.F.R. § 4.14. Although it is possible for a veteran to have separate and distinct manifestations from the same injury which would permit rating under several diagnostic codes, the critical element in permitting the assignment of several evaluations under various diagnostic codes is that none of the symptomatology for any one of the conditions is duplicative or overlapping with the symptomatology of the other condition. See Esteban v. Brown, 6 Vet. App. 259, 261-62 (1994). Here, the Veteran’s sleep difficulties are already considered as a symptom of his PTSD in his psychiatric evaluations and in the considerations of the assigned PTSD disability rating. As noted, no separate sleep disorder such as sleep apnea has been clinically established. As such, a separate rating may not be assigned for the chronic sleep impairment. Accordingly, the Veteran’s entitlement claim for service connection for a sleep disorder must be denied. 2. Entitlement to service connection for oral cancer is denied. In December 2014, the Veteran submitted his VA Form 21-526EZ. Therein, the Veteran initiated his entitlement claim for service connection for oral cancer, resulting from Desert Storm service. Again, establishing service connection generally requires competent evidence showing: (1) the existence of a current disability; (2) 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. Shedden v. Principi, 381, F.3d 1163, 1167 (Fed. Cir. 2004). Service connection may also be granted for any disease 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). In addition to the framework identified above, service connection may be established for a Persian Gulf Veteran who exhibits objective indications of chronic disability which cannot be attributed to any known clinical diagnosis, but which instead results from an undiagnosed illness that became manifest either during active service in the Southwest Asia theater of operations during the Persian Gulf War, or to a degree of 10 percent or more not later than December 31, 2016. 38 C.F.R. § 3.317 (a)(1)(i). See also 76 Fed. Reg. 81834 (Dec. 29, 2011). A Persian Gulf Veteran is one who served in the Southwest Asia theater of operations during the Persian Gulf War. Id. The Southwest Asia theater of operations includes Iraq, Kuwait, Saudi Arabia, the neutral zone between Iraq and Saudi Arabia, Bahrain, Qatar, the United Arab Emirates, Oman, the Gulf of Aden, the Gulf of Oman, the Persian Gulf, the Arabian Sea, the Red Sea, and the airspace above these locations. 38 C.F.R. § 3.317 (d)(2). Objective indications of a chronic disability include both “signs,” in the medical sense of objective evidence perceptible to an examining physician, and other, non-medical indicators that are capable of independent verification. Disabilities that have existed for six months or more and disabilities that exhibit intermittent episodes of improvement and worsening over a 6-month period will be considered chronic. The 6-month period of chronicity will be measured from the earliest date on which the pertinent evidence establishes that the signs or symptoms of the disability first became manifest. A disability referred to in this section shall be considered service-connected for the purposes of all laws in the United States. 38 C.F.R. §§ 3.317 (a)(2)-(5). Effective March 1, 2002, the law affecting compensation for disabilities occurring in Persian Gulf War Veterans was amended. 38 U.S.C. §§ 1117, 1118. Essentially, these changes revised the term “chronic disability” to “qualifying chronic disability,” and involved an expanded definition of “qualifying chronic disability” to include: (a) an undiagnosed illness, (b) a medically unexplained chronic multi-symptom illness (such as chronic fatigue syndrome, fibromyalgia, and irritable bowel syndrome) that is defined by a cluster of signs or symptoms, or (c) any diagnosed illness that the Secretary determines, in regulations, warrants a presumption of service connection. 38 U.S.C. § 1117 (a)(2)(B); 38 C.F.R. § 3.317. The term “medically unexplained chronic multisymptom illness” means a diagnosed illness without conclusive pathophysiology or etiology, that is characterized by overlapping symptoms and signs and has features such as fatigue, pain, disability out of proportion to physical findings, and inconsistent demonstration of laboratory abnormalities. Chronic multisymptom illnesses of partially understood etiology and pathophysiology will not be considered medically unexplained. 38 C.F.R. § 3.317 (a)(2)(ii). With claims based on undiagnosed illness, the Veteran is not required to provide competent evidence linking a current disability to an event during service. Gutierrez v. Principi, 19 Vet. App. 1 (2004). Signs or symptoms that may be a manifestation of an undiagnosed illness or a chronic multi-symptom illness include: fatigue, unexplained rashes or other dermatological signs or symptoms, headache, muscle pain, joint pain, neurological signs and symptoms, neuropsychological signs or symptoms, signs or symptoms involving the upper or lower respiratory system, sleep disturbances, gastrointestinal signs or symptoms, cardiovascular signs or symptoms, abnormal weight loss, and menstrual disorders. 38 U.S.C. § 1117 (g); 38 C.F.R. § 3.317 (b). Section 1117(a) of Title 38 of the United States Code authorizes service connection on a presumptive basis only for disability arising in Persian Gulf Veterans due to “undiagnosed illness” and may not be construed to authorize presumptive service connection for any diagnosed illness, regardless of whether the diagnosis may be characterized as poorly defined. See VAOPGCPREC 8-98 (Aug. 3, 1998). Compensation may be paid under 38 C.F.R. § 3.317 for disability which cannot, based on the facts of the particular veteran’s case, be attributed to any known clinical diagnosis. The fact that the signs or symptoms exhibited by the veteran could conceivably be attributed to a known clinical diagnosis under other circumstances not presented in the particular veteran’s case does not preclude compensation under § 3.317. Id. However, if the above referenced statutory presumptions are not met, a Veteran is not precluded from establishing service connection with proof of actual direct causation. See Combee v. Brown, 34 F.3d 1039 (Fed. Cir. 1994). The determination of whether the requirements of service connection have been met is based on an analysis of all the evidence of record and the evaluation of its credibility and probative value. See Baldwin v. West, 13 Vet. App. 1, 8 (1999). In making these determinations, the Board must consider and assess the credibility and weight of all evidence in the claim file, including the medical and lay evidence, to determine its probative value. In doing so, the Board must provide its reasoning for rejecting any evidence favorable to the claimant. See Masors v. Derwinski, 2 Vet. App. 181 (1992); Wilson v. Derwinski, 2 Vet. App. 614, 618 (1992); Barr v. Nicholson, 21 Vet. App. 303 (2007). The determination of whether the requirements of service connection have been met is based on an analysis of all the evidence of record and the evaluation of its credibility and probative value. See Baldwin v. West, 13 Vet. App. 1, 8 (1999). In making these determinations, the Board must consider and assess the credibility and weight of all evidence in the claim file, including the medical and lay evidence, to determine its probative value. In doing so, the Board must provide its reasoning for rejecting any evidence favorable to the claimant. See Masors v. Derwinski, 2 Vet. App. 181 (1992); Wilson v. Derwinski, 2 Vet. App. 614, 618 (1992); Barr v. Nicholson, 21 Vet. App. 303 (2007). When there is an approximate balance of evidence regarding the merits of an issue material to the determination of the matter, the benefit of the doubt in resolving each issue shall be given to the claimant. See 38 U.S.C. § 5107; 38 C.F.R. §§ 3.102, 4.3. A claimant need only demonstrate an approximate balance of positive and negative evidence in order to prevail. See Gilbert v. Derwinski, 1 Vet. App. 49, 53 (1990). For a claim to be denied on the merits, a preponderance of the evidence must be against the claim. See Alemany v. Brown, 9 Vet. App. 518, 519 (1996). That being the relevant, generalized law, applicable to the Veteran’s claim, the Board finds that the evidence does not support or warrant a grant of entitlement to service connection for oral cancer. Before assessing the merits of the Veteran’s entitlement claim for oral cancer, the board finds that the Veteran is a “Persian Gulf Veteran” for VA compensation purposes. 38 U.S.C. § 1117. The Veteran served as a member of the United States Marine Corps, with active duty service during the Persian Gulf War. The Veteran's DD 214 confirms that he is in receipt of the Southwest Asia Service Medal with two stars. As such, the Veteran is considered a Persian Gulf Veteran. Despite being a Persian Gulf Veteran, the Board finds that the Veteran’s oral cancer is attributable to known clinical diagnoses; and therefore, the Veteran is not entitled to an award based upon the presumptions as outlined in 38 C.F.R. § 3.317. Furthermore, and as will be discussed in greater detail below, the Board finds the Veteran is not entitled to award of direct service connection for his oral cancer. In December 2014, the Veteran’s private treatment records were associated with his claims file. Therein, in September 2014, Dr. Miley entered a notation at Baptist Health Systems. At that time, Dr. Miley entered a diagnosis for “bleeding from tongue, oral cancer.” The notation from Dr. Miley substantiates the first requisite element of an entitlement claim for service connection, a current diagnosed disability. Shedden, 381, F.3d at 1167. In January 2015, the Veteran’s service treatment records (STRs) were associated with his claims file. After careful and deliberate review, the Board did not identify a single notation that would support an in-service incurrence of oral cancer. The Board concludes that the lack of in-service evidence, and the two-decade span between Veteran’s separation from the Marine Corps and his oral cancer diagnosis, does not substantiate the second requisite element of a direct service-connection claim. In April 2015, a Gulf War General Medical Examination Disability Benefits Questionnaire (DBQ) was generated. After review of the Veteran’s claims file, Dr. TES remarked that, “(t)his Veteran gives no history of illnesses suggestive of a Gulf War syndrome. He has a PH of psoriasis and cancer of the tongue, unrelated to his Gulf War experience. The tongue cancer is a relatively common disorder in the general population and carries risk factors of tobacco use, alcohol and HPV virus infection. This Veteran has not used tobacco, but in the past used alcohol and has been sexually active. There is no clear scientific evidence that environmental exposures during the Gulf War results in this disorder. These exposures are not known causes of tongue cancer.” In June 2015, the Veteran submitted his notice of disagreement (NOD). Therein, the Veteran posited that, “I feel that the ‘airborne hazards & open burn pit registry’ were overlooked in the oral . . . cancer decision.” In October 2016, the Veteran submitted his VA Form 9. Therein, the Veteran posited that, “I believe that I should be service connected for my oral cancer based on the environmental hazards I was exposed to while on active duty. In Kuwait . . . I was around open burn pit smoke and oil fires on a daily basis . . .. I was diagnosed in August 2014 with oral cancer and surgery was done to remove most of my tongue. . . . I was asked many questions about my history and I did not meet the normal case. I did not smoke and had never smoked. The ONLY time I was exposed to smoke was during my active duty in Kuwait from Aug 1990 to May 1991. I was exposed to the smoke and fumes from the open burn pits and oil fires frequently while stationed in Kuwait.” In December 2017, the Veteran supplied sworn testimony to a decision review officer DRO. At that time, the Veteran averred that, “because of . . . oral cancer, my health has gone downhill at a very rapid pace. I believe it was all as a result of Operation Desert Shield, Operation Desert Storm, Operation Restore Hope, and the airborne hazards of the open burn pits.” When asked whether cancer ran in his family, the Veteran responded, “No, not nothing like this, no.” The Board acknowledges and appreciates the various statements from the Veteran about the cause of his oral cancer. The Board notes that while the Veteran is competent to testify about the symptoms he has observed during the course of his disability, he lacks the experience, training and eduction to competently identify the etiology of his oral cancer. See Clemons v. Shinseki, 23 Vet. App. 1, 4-5 (2009)(citing Espiritu v. Derwinski, 2 Vet. App. 492, 494-95 (1992)). In January 2018, VA received correspondence from the Cook County Health and Hospitals System. Therein, Dr. MQ revealed that, “(the Veteran) is a pleasant gentleman who underwent a subtotal glossectomy and bilateral neck dissections with an anterolateral thigh free flap reconstruction for a Stage IV tongue cancer. This was followed up by post operative adjuvant therapy. He required speech and swallow therapy after surgery due to the significant disability that was caused by his cancer and surgery. (The Veteran) was not a tobacco smoker. He reports being in the marine corp and being exposed to fumes while serving in Desert Storm and in Somalia. While there is no published data to suggest that fumes from chemicals cause oral cancer, it can not be ruled out as a possibility. Further studies would be needed in this area.” The Board concludes the evidence within the Veteran’s claims file fails to substantiate the third requisite element of a direct service-connection claim. Shedden, 381, F.3d at 1167. Meaning, there is no competent medical evidence to support a nexus between the Veteran’s oral cancer and active duty service. In April 2015, Dr. TES opined that, “(t)here is no clear scientific evidence that environmental exposures during the Gulf War results in this disorder. These exposures are not known causes of tongue cancer.” In January 2018, Dr. MQ opined that, “(the Veteran) reports being in the marine corp and being exposed to fumes while serving in Desert Storm and in Somalia. While there is no published data to suggest that fumes from chemicals cause oral cancer, it can not be ruled out as a possibility (emphasis added).” Ultimately, the Board finds that the preponderance of the evidence stands counter to the Veteran’s entitlement claim for service connection for oral cancer. Since the preponderance of the evidence is against this oral cancer claim, the provisions of 38 U.S.C. § 5107(b), regarding reasonable doubt, are not applicable. The   Veteran’s claim of entitlement to service connection for oral cancer must be denied, because the preponderance of the evidence weighs against his claim. DAVID L. WIGHT Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD RLBJ, Associate Counsel