Citation Nr: 19149656 Decision Date: 06/25/19 Archive Date: 06/25/19 DOCKET NO. 09-19 856 DATE: June 25, 2019 ORDER Entitlement to service connection for prostatic hypertrophy, including as secondary to in service tactical herbicide exposure or as secondary to the service-connected renal cell carcinoma, is denied. Entitlement to service connection for a skin disorder, including as secondary to in service tactical herbicide exposure, is denied. FINDINGS OF FACT 1. The preponderance of the evidence is against finding that the Veteran’s benign prostatic hypertrophy is related to his service (including in-service tactical herbicide exposure) or was caused or aggravated by his service-connected renal cell carcinoma. 2. The preponderance of the evidence is against a finding that the Veteran’s skin disorder is related to his active service, including in-service tactical herbicide exposure. CONCLUSIONS OF LAW 1. The criteria for service connection for benign prostatic hypertrophy, including as secondary to in-service tactical herbicide exposure or as secondary to the service-connected renal cell carcinoma, have not been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R § 3.102, 3.303, 3.307, 3.309, 3.310 (2018). 2. The criteria for service connection for a skin disorder, to include as secondary to in service tactical herbicide exposure have not been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R § 3.102, 3.303, 3.307, 3.309 (2018). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran had active service from November 1961 to November 1967. This appeal comes to the Board following a December 2017 Board decision and remand, wherein the issue of service connection for a skin condition or rash was remanded for a VA examination and etiology opinion, and the issue of service connection for prostatic hypertrophy was remanded for an addendum opinion concerning its etiology in relation to the Veteran’s service-connected renal cell carcinoma. The Board’s December 2017 decision/remand, in addition to the Board decision/remand of December 2014, is incorporated herein by reference. Both opinions requested in the December 2017 remand have been obtained, and the case has returned to the Board for adjudication. It is worthy of note that the Veteran was asked to provide information for any outstanding private treatment records, and no response was received by VA. Service Connection Service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. § 1110, 1131. Generally, the evidence must show: (1) the existence of a present 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, 1166 -67 (Fed. Cir. 2004); Caluza v. Brown, 7 Vet. App. 498, 505 (1995). Certain chronic diseases are subject to presumptive service connection if manifest to a compensable degree within one year from separation from service even though there is no evidence of such disease during the period of service. This presumption is rebuttable by affirmative evidence to the contrary. 38 U.S.C. §§ 1112, 1113; 38 C.F.R. §§ 3.307 (a)(3), 3.309(a). Service connection may be established for any disability which is proximately due to or the result of a service-connected disease or injury. 38 C.F.R. § 3.310. To prevail on the issue of entitlement to secondary service connection, there must be (1) evidence of a current disability; (2) evidence of a service-connected disability; and (3) nexus evidence establishing a connection between the service-connected disability and the current disability. Wallin v. West, 11 Vet. App. 509, 512 (1998). Regulations also provide that service connection may be granted for a disability diagnosed after discharge, when all the evidence, including that pertinent to service, establishes that the disability is due to disease or injury which was incurred in or aggravated by service. 38 C.F.R. § 3.303(d). Veterans diagnosed with an enumerated disease who, during active 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 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 C.F.R. § 3.307(a)(6)(iii). The analyses below focus on the most salient and relevant evidence and on what this evidence shows or fails to show. The Veteran should not assume that the Board has overlooked pieces of evidence that are not specifically discussed herein. Timberlake v. Gober, 14 Vet. App. 122 (2000). The law requires only that the Board provide reasons for rejecting evidence favorable to the Veteran. 1. Prostatic hypertrophy, including as secondary to in service tactical herbicide exposure or to the service-connected renal cell carcinoma The Veteran contends that his diagnosed benign prostatic hypertrophy (BPH) is related to his active service, to include as secondary to tactical herbicide exposure, or as secondary to his service-connected renal cell carcinoma. The Board finds that the preponderance of the evidence is against finding that the Veteran’s BPH is related to his service (including in-service tactical herbicide exposure) or was caused or aggravated by his service-connected renal cell carcinoma. On VA examination in July 2017, the examiner opined that the Veteran’s BPH was less likely as not secondary to his service-connected renal cell carcinoma. Renal cell carcinoma itself is not a cause of benign prostatic hypertrophy. Risk factors for the condition include advancing age, race, family history of bladder cancer, elevated testosterone and/or estradiol levels, obesity, inactivity, increased alcohol consumption and frequent prostatitis, among others. The Veteran argued that the July 2017 opinion was inadequate because secondary service-connection was not considered. Following the Board’s December 2017 remand, an additional review medical opinion was obtained in October 2018 from the same examiner. The examiner explained that the Veteran’s BPH, including his urinary symptoms, are not aggravated by his renal cell carcinoma. The Veteran had a partial nephrectomy for renal cell carcinoma of the right kidney in September 2007. February VA primary care medical notes do not show any problems with urination. Therefore, the Veteran’s surgery did not cause urination problems. VA notes indicate that the first time the Veteran complained of urine incontinence was around February 2012, five years after the kidney surgery for renal cell carcinoma. Therefore, the kidney surgery did not cause the urinary issues. Further, repeated urology notes state that the cause of the Veteran’s urinary symptoms are overactive bladder and an enlarged prostate. The examiner added that literature research indicates that BPH is not caused by tactical herbicide exposures. Medically accepted theories for causes of BPH are advancing age, race, family history of bladder cancer, elevated testosterone and/or estradiol levels, obesity, inactivity, increased alcohol consumption and frequent recurring episodes of prostatitis, among others. The Board notes that benign prostatic hypertrophy is not among the enumerated diseases or conditions presumed to be service connected in 38 C.F.R. § 3.307 (a)(6)(iii). The Board finds the preponderance of the evidence is against a finding that the Veteran’s BPH is related to his presumed exposure to tactical herbicide agents or has been caused or aggravated beyond its normal progression by his service-connected renal cell carcinoma. The medical evidence shows that this condition does not warrant service connection. The Veteran has not provided any evidence or argument to the contrary. Therefore, the appeal must be denied. 2. Skin disorders, including as secondary to in-service tactical herbicide exposure The Veteran contends that his diagnosed skin disorder, to include rashes, lipomas, edema, and status dermatitis, is related to his active service, including as secondary to tactical herbicide agents. The Board finds the preponderance of the evidence is against a finding that the Veteran’s skin condition is related to his active service. According to a February 2008 statement, Dr. S.Q. believed the Veteran’s lymph edema and stasis contact dermatitis developed as a result of exposure to Agent Orange. There was no accompanying rationale or explanation of this statement. The December 2017 remanded noted that a June 2012 examination for diabetes-related peripheral neuropathy attributed the edema in the Veteran’s legs to his peripheral neuropathy. Thus, the examiner was instructed to address Dr. S.Q.’s 2008 statement. On VA examination in November 2018, following an in-person examination and history, the examiner opined that the Veteran’s skin condition was less likely than not incurred in, or caused by, the claimed in-service injury, event or illness. There were no service records found showing symptoms of or diagnosed conditions concerning skin rashes, lipomas, edema, or stasis dermatitis. There were no records concerning the Veteran’s claimed skin conditions within one year of his separation from active service. The onset of the Veteran’s skin condition was years after discharge from service. The claimed rash is the result of skin changes related to status dermatitis and edema. The examiner further explained that the Veteran’s skin discoloration condition is directly related to venous insufficiency with resulting skin changes of stasis dermatitis. Venous insufficiency is the direct result of aging. The February 2008 opinion provided no medical evidence upon which the doctor formulated his opinion. The opinion was not based on any objective medical evidence. Finally, the November 2018 examiner stated that research regarding the effects of Agent Orange resulted in no medical literature reporting venous insufficiency, lower extremity rash or edema, or stasis dermatitis as being related to Agent Orange. It is not likely that the Veteran's skin condition is the result of tactical herbicide exposure. The Board finds that the VA examiner’s opinion, including a thorough rationale, is persuasive in finding that the Veteran’s skin conditions are not a result of his active service, including his in service tactical herbicide exposure. The February 2008 opinion, while positive, provides no context or rationale, and is therefore given less probative value in establishing service connection in light of the well-reasoned November 2018 opinion. Therefore, service connection for the claimed skin condition is denied. THERESA M. CATINO Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD M.E. Lee, Associate 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.