Citation Nr: 19190863 Decision Date: 12/03/19 Archive Date: 12/03/19 DOCKET NO. 13-31 717 DATE: December 3, 2019 ORDER Service connection for rectal cancer is denied. Service connection for chronic myelogenous leukemia is denied. FINDING OF FACT The Veteran’s rectal cancer and chronic myelogenous leukemia first manifested many decades following his separation from his service; and they are not caused or aggravated by his service, to include his presumed exposure to herbicide agents. CONCLUSIONS OF LAW 1. The criteria for service connection for rectal cancer, to include as due to exposure to herbicide agents, have not been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309. 2. The criteria for service connection for chronic myelogenous leukemia, to include as due to exposure to herbicide agents, have not been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309. REASONS AND BASES FOR FINDING AND CONCLUSIONS The Veteran served on active duty from July 1970 to January 1972, to include service in the Republic of Vietnam. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a December 2010 rating decision issued by the Department of Veterans Affairs (VA) Regional Office (RO) in Chicago, Illinois. In August 2017, the Veteran testified before the undersigned. A transcript is of record. In November 2017, the Board remanded the appeal for additional development. Service Connection Service connection may be granted for disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. § 3.303. The three-element test for service connection requires evidence of: (1) a current disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the current disability and the in-service disease or injury. Shedden v. Principi, 381 F.3d 1163, 1166 -67 (Fed. Cir. 2004). Additionally, where a veteran who served for ninety days or more during a period of war develops certain chronic diseases to a degree of 10 percent or more within one year from separation from service, such diseases may be presumed to have been incurred in service even though there is no evidence of such disease during the period of service. 38 C.F.R. §§ 3.307, 3.309 Rectal cancer and chronic myelogenous leukemia The Veteran contends that he has rectal cancer and chronic myelogenous leukemia are due to his service, to include exposure to herbicide agents. See October 2013 Statement. He served in the Republic of Vietnam during the Vietnam Era. His in-service exposure to herbicide agents is presumed. 38 U.S.C. § 1116(f); 38 C.F.R. § 3.307. Service treatment records do not contain any complaints or treatments related to rectal cancer or chronic myelogenous leukemia. Post service, the Veteran has been diagnosed with rectal cancer since April 2005, see March 2009 Private treatment note, and chronic myelogenous leukemia since August 2003, see January 2010 Letter from Dr. P.P.G. The key question is whether these diagnoses are related to the Veteran’s service, to include his exposure to herbicide agents. The preponderance of evidence demonstrates that the claimed conditions are not related to the Veteran’s exposure to herbicide agents. To that end, a March 2018 VA examiner concluded that the Veteran’s rectal cancer was less likely as not related to service including his exposure to herbicide agents. She reasoned that current medical literature fails to show any positive relationship between rectal cancer and herbicide agent exposure and opined that the claimed rectal cancer was more likely due to “increasing age . . . smoking, family history, high-fat diet, or a history of polyps or colorectal cancer or inflammatory bowel disease,” which were known risk factors. As for the claimed chronic myelogenous leukemia, the examiner also rendered a negative nexus opinion. As rationale, she explained that chronic myelogenous leukemia is “caused by a chromosome mutation that occurs spontaneously” and that current medical literature fails to support a relationship between the condition and herbicide agent exposure. Service treatment records were otherwise silent for any symptoms or treatments related to both claimed disabilities. The March 2018 examiner’s opinions are based on full consideration of the pertinent evidence of record and are supported by the underlying reasons for the conclusions offered. As such, the Board assigns significant probative value to these opinions. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008); Stefl v. Nicholson, 21 Vet. App. 120, 124 (2007). The Veteran has submitted letters from his private physicians, see January 2010 Letter from Dr. P.P.G.; March 2010 Letter from Dr. G.T., in which the private physicians merely noted the current diagnoses for the claimed disabilities and the Veteran’s history of herbicide agent exposure. Neither physician offered a clear conclusion or any underlying rationale linking those current diagnoses to the Veteran’s exposure to herbicide agents. As such, these statements have minimal probative value. See Obert v. Brown, 5 Vet. App. 30, 33 (1993); Nieves-Rodriguez, 22 Vet. App. at 304. There is no presumption for either of the claimed disabilities based on herbicide exposure; however, there is a presumption for certain chronic disabilities, to include both claimed here. See 38 C.F.R. § 3.309(a). While both disabilities are listed among conditions recognized as chronic, the record is devoid of any evidence that they manifested to a compensable degree within a year of separation, and the Veteran’s service treatment records fail to show any complaints ore treatments referable to rectal cancer or chronic myelogenous leukemia. Indeed, the Veteran was not diagnosed with these conditions for many decades since his separation from service in January 1972 (i.e., rectal cancer was first diagnosed in April 2005 and chronic myelogenous leukemia in August 2003). Therefore, the requirements for the presumption of service connection for certain chronic disabilities have not been met. See 38 C.F.R. §§ 3.307, 3.309(a). As for lay assertions of medical nexus, the claim under consideration fundamentally turns on whether there is a link between the Veteran’s claimed rectal cancer and chronic myelogenous leukemia and his service, to specifically include exposure to herbicide agents. While lay persons are competent to provide opinions on some medical issues, the diagnoses and etiologies of rectal cancer and chronic myelogenous leukemia are complex medical matters in the field of oncology that fall outside the realm of common knowledge of a lay person. See Jandreau v. Nicholson, 492 F.3d 1372, 1377 n.4 (Fed. Cir. 2007). Neither the Veteran nor his representative is shown to have the education, training or experience to competently opine as to diagnosis and medical nexus of the claimed disabilities. Their lay statements have minimal probative value, and significant probative values have been assigned to the March 2018 VA examiner’s opinions for reasons articulated above. As the preponderance of the evidence is against the Veteran’s claims, the “benefit of the doubt” doctrine is not applicable, and the appeal must be denied. 38 U.S.C. § 5107; 38 C.F.R. § 3.102. The Board is grateful for the Veteran’s honorable service and regrets that a more favorable outcome could not be reached. Bethany L. Buck Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board S. Kim, Counsel The Board’s decision in this case is binding only with respect to the instant matter decided. This decision is not precedential, and does not establish VA policies or interpretations of general applicability. 38 C.F.R. § 20.1303.