Citation Nr: 19166290 Decision Date: 08/27/19 Archive Date: 08/27/19 DOCKET NO. 14-15 635A DATE: August 27, 2019 ORDER Entitlement to service connection for the cause of the Veteran’s death is denied. FINDINGS OF FACT 1. The Veteran died in March 2010 at his home. The death certificate lists the immediate or underlying cause of death as “pancreatic cancer.” No contributory cause of death was listed. No autopsy was performed. 2. At the time of the Veteran’s death in March 2010, the Veteran was not service connected for any disabilities by VA. 3. The Veteran had active service in the Republic of Vietnam during the Vietnam era and is presumed to have been exposed to herbicides during such service. 4. The principal cause of the Veteran’s death, pancreatic cancer, did not manifest in service, or within one year thereafter, and is not related to his active service from 1966 to 1968, including to his presumed herbicide exposure in Vietnam. CONCLUSION OF LAW The criteria are not met for service connection for the cause of the Veteran’s death. 38 U.S.C. §§ 1101, 1110, 1112, 1113, 1116, 1310, 5107; 38 C.F.R. §§ 3.1, 3.5, 3.102, 3.303, 3.307, 3.309, 3.312, 3.313. REASONS AND BASES FOR FINDINGS AND CONCLUSION The Veteran had active duty service in the United States Army from August 1966 to August 1968. The Veteran served in the Republic of Vietnam. The Veteran died in March 2010. The appellant is seeking to be recognized as the Veteran’s surviving spouse. This matter comes before the Board of Veterans’ Appeals (BVA or Board) on appeal from September 2013 and December 2013 decisions issued by the Department of Veterans Affairs (VA) Regional Office (RO) in St. Paul, Minnesota. Jurisdiction of the case has since been transferred to the RO in Waco, Texas. That office forwarded the appeal to the Board. In October 2016, the appellant testified at a Board videoconference hearing before the undersigned Veterans Law Judge. A transcript of that hearing is associated with the claims file. In February 2018, the Board remanded the appeal for further development. This case has since been returned to the Board for appellate review, after the RO substantially complied with the Board’s remand order. Stegall v. West, 11 Vet. App. 268, 271 (1998). In the same February 2018 Board decision, the Board recognized the appellant as the Veteran’s surviving spouse for purposes of entitlement to Dependency and Indemnity Compensation (DIC) benefits. This finding was based on the appellant and the Veteran having a valid common law marriage in the State of Texas from 1991 until the Veteran’s death in 2010. See 38 C.F.R. §§ 3.1, 3.50. Therefore, this previous threshold issue of recognition of the appellant as the surviving spouse of the Veteran is no longer on appeal before the Board. I. VA’s Duty to Notify and Assist The Veterans Claims Assistance Act of 2000 (VCAA), in part, describes VA’s duties to notify and assist claimants in substantiating a claim for VA benefits. 38 U.S.C. § §§ 5100, 5102, 5103, 5103A, 5106, 5107, 5126 (2012); Honoring America’s Veterans and Caring for Camp Lejeune Families Act of 2012, Pub. L. No. 112-154, §§ 504, 505, 126 Stat. 1165, 1191-93; 38 C.F.R. §§ 3.102, 3.156(a), 3.159, 3.326(a) (2018). The VCAA applies to the instant service connection claim for the cause of the Veteran’s death. However, review of the claims file reveals compliance with VA's duty to notify by way of VCAA letters dated in July 2013, August 2018, and December 2018. In particular, the United States Court of Appeals for Veterans Claims (Court) has held that additional, detailed notice requirements apply in the context of a claim for DIC benefits based on service connection for the cause of death. In particular, this notice must include: (1) a statement of the conditions, if any, for which a veteran was service-connected at the time of his or her death; (2) an explanation of the evidence and information required to substantiate a DIC claim based on a previously service-connected condition; and (3) an explanation of the evidence and information required to substantiate a DIC claim based on a condition not yet service-connected. Hupp v. Nicholson, 21 Vet. App. 342 (2007), rev’d on other grounds, Hupp v. Shinseki, 329 Fed. Appx. 277 (Fed. Cir. May 19, 2009) (unpublished). In this case, the RO provided the appellant with a July 2013 notice letter compliant with the above requirements of the Hupp case. In any event, neither the appellant nor her representative has raised any issues with the duty to notify or duty to assist, subsequent to the ameliorative February 2018 Board remand. See Scott v. McDonald, 789 F.3d 1375, 1381 (Fed. Cir. 2015) (holding that "the Board's obligation to read filings in a liberal manner does not require the Board... to search the record and address procedural arguments when the veteran fails to raise them before the Board."); Dickens v. McDonald, 814 F.3d 1359, 1361 (Fed. Cir. 2016) (applying Scott to a duty to assist argument). In this regard, all necessary private hospice records and VA medical opinions were secured after the February 2018 Board remand. That is, the Board secured VA medical opinions addressing what relationship, if any, exists between the cause of the Veteran’s death and his military service. See 38 U.S.C. § 5103A(a); DeLaRosa v. Peake, 515 F.3d 1319, 1322 (Fed. Cir. 2008); Wood v. Peake, 520 F.3d 1345 (Fed. Cir. 2008). And most importantly, the May 2019 Appellant’s Brief is silent for any allegation of any further duty to notify or duty to assist problems. The appellant’s representative stated that the January 2019 VA medical opinion addressed “all reasonable avenues of service connection.” II. SC Cause of Death DIC is a monthly monetary benefit that is payable to a surviving spouse, child, or parent because of the service-connected death of a Veteran. 38 U.S.C. § § 101(14) (2012); 38 C.F.R. § 3.5(b) (2018). Entitlement to DIC benefits can be claimed on the specific form prescribed by the secretary. 38 C.F.R. §§ 3.150(b), 3.152(a). There are three main theories of entitlement to DIC benefits: (1) benefits awarded pursuant to 38 U.S.C. § 1310; (2) benefits awarded pursuant to 38 U.S.C. § 1318; and, (3) benefits awarded pursuant to 38 U.S.C. § 1151. Unless specifically limited by a claimant, the Board is required to consider all theories of entitlement to DIC benefits. See 38 C.F.R. § 3.152(a), (b)(1). In the present case, DIC benefits pursuant to either 38 U.S.C. § 1318 or 38 U.S.C. § 1151 do not apply to the appellant’s case. In any event, among the three primary theories, 38 U.S.C. § 1310 for cause of death provides the greatest benefit. See 38 C.F.R. § 3.151. DIC benefits under 38 U.S.C. § 1310, commonly referred to as “service connection for cause of death claims,” may be awarded when the Veteran died either (1) during active service or (2) died from a disability deemed to be related to a period of active service from which he received a qualifying discharge. 38 U.S.C. § 1310(b). Generally, a veteran's death is service connected if it resulted from a disability incurred or aggravated in the line of duty during active military, naval, or air service. 38 U.S.C. §§ 101(16), 1110; 38 C.F.R. §§ 3.1(k), 3.303. For deaths after active service, such as current Veteran’s death in March 2010, the death will be considered to have been due to a service-connected disability when there is evidence that this service-connected disability was either the principal or contributory cause of death. 38 C.F.R. § 3.312(a). A service-connected disability is the principal cause of death if it singly or jointly with another condition, was the immediate or underlying cause of death, or was etiologically related to the death. 38 C.F.R. § 3.312(b). A service-connected disability is a contributory cause of death if it contributed substantially or materially to the cause of death, combined to cause death, or aided or lent assistance to producing death - e.g., when a causal (not just a casual) connection is shown. 38 C.F.R. § 3.312(c). But a contributory cause of death is one that is inherently not related to the principal cause of death. Id. A medical opinion is necessary in order to make any contributory cause of death determination. See generally Colvin v. Derwinski, 1 Vet. App. 171 (1991). In the present case, the Veteran died in March 2010 at his home. The death certificate lists the immediate or underlying cause of death as “pancreatic cancer.” No contributory cause of death was listed. At present, his pancreatic cancer is a nonservice-connected disability. In fact, at the time of the Veteran’s death in March 2010, service connection had not been established for any disabilities. His death certificate noted that tobacco did not contribute to death. No autopsy was performed. The appellant contends that the immediate cause of the Veteran’s death listed on his death certificate (pancreatic cancer) was the result of his presumed exposure to herbicide agents (Agent Orange) while the Veteran was stationed in Vietnam from August 1967 to August 1968 during active service. Thus, she believes the Veteran’s pancreatic cancer is a service-connected cause of death. She explains that during his lifetime, the Veteran was unaware he could apply for benefits based on his presumed Agent Orange exposure in Vietnam. But she maintains that in January 2010, two months prior to his death, one of his physicians advised the appellant that the Veteran’s pancreatic cancer “could be” due to his in-service Agent Orange exposure. In addition, she states that malaria the Veteran contracted in-service in Vietnam may be the cause of his pancreatic cancer. See July 2013 DIC claim (VA Form 21-534); October 2014 VA Form 9; October 2016 videoconference hearing testimony; and May 2019 Appellant’s Brief. However, at the time of his death, as mentioned above, service connection had not been established for any pancreatic cancer disability. Thus, the central issue in the present cause of death case is whether service connection is warranted for the Veteran’s pancreatic cancer. Service connection may be granted for disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. § 3.303. In addition, disorders diagnosed after discharge may also still be service connected if all the evidence, including pertinent service records, establishes the disorder was incurred in service. 38 C.F.R. § 3.303(d). See Combee v. Brown, 34 F.3d 1039, 1043 (Fed. Cir. 1994). The three-element test for service connection requires evidence of: (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 current disability and the disease or injury incurred or aggravated during service — the “nexus” requirement. Holton v. Shinseki, 557 F.3d 1363, 1366 (Fed. Cir. 2009) (quoting Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004)). In the present case, the Veteran’s malignant tumor in the pancreas is an enumerated “chronic disease” listed under 38 C.F.R. § 3.309(a); therefore, 38 C.F.R. § 3.303(b) applies. Walker v. Shinseki, 708 F.3d 1331, 1338-39 (Fed. Cir. 2013). Under 38 C.F.R. § 3.303(b), where the evidence shows an enumerated “chronic disease” in service (or within the presumptive period under § 3.307), or “continuity of symptoms” of such a disease after service, the disease shall be presumed to have been incurred in service. Walker, 708 F.3d 1335-1337. Service connection for certain enumerated diseases, such as a malignant tumor in the pancreas, may be also be established on a presumptive basis by showing that it manifested itself to a degree of 10 percent or more within one year from the date of separation from service. 38 U.S.C. §§ 1101, 1112, 1113; 38 C.F.R. §§ 3.307(a)(3), 3.309(a). VA is to give “due consideration” to “all pertinent medical and lay evidence” in evaluating a claim for disability benefits. 38 U.S.C. § § 1154(a). Thus, there is no categorical rule that medical evidence is required when the determinative issue is either medical etiology or a medical nexus. Davidson v. Shinseki, 581 F.3d 1313, 1316 (Fed. Cir. 2009). The Veteran’s spouse, when competent, can in certain instances establish a nexus between the Veteran’s death and an in-service disease or injury. Davidson, 581 F.3d at 1315-16. Therefore, a medical opinion is not always required to establish such a nexus. Id. As such, the Board will assess the competence and credibility of lay statements in the present case. Barr v. Nicholson, 21 Vet. App. 303, 308 (2007). In determining whether service connection is warranted, the Board shall consider the benefit-of-the-doubt doctrine. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102; Alemany v. Brown, 9 Vet. App. 518 (1996); Gilbert v. Derwinski, 1 Vet. App. 49 (1991). Upon review of the evidence of record, the Board finds that service connection for the cause of the Veteran’s death is not warranted. Although it is undisputed that the Veteran’s pancreatic cancer was a principal cause of his death under 38 C.F.R. § 3.312(b), his pancreatic cancer is not related to his presumed Agent Orange exposure during his active service in Vietnam. With regard to presumptive service connection, the law provides that certain diseases associated with exposure to certain herbicide agents used in support of military operations in the Republic of Vietnam during the Vietnam era will be considered to have been incurred in service, even if there is no record of the disease during service. 38 U.S.C. § 1116(a)(1); 38 C.F.R. § 3.307(a)(6). The following disorders are associated with herbicide exposure for purposes of this presumption: AL amyloidosis, chloracne or other acneform disease consistent with chloracne, type II diabetes (also known as type II diabetes mellitus or adult-onset diabetes), Hodgkin’s disease, ischemic heart disease, all chronic B-cell leukemias (including, but not limited to, hairy-cell leukemia and chronic lymphocytic leukemia) multiple myeloma, Non-Hodgkin’s lymphoma, Parkinson’s disease, early-onset peripheral neuropathy, porphyria cutanea tarda, prostate cancer, respiratory cancers (cancer of the lung, bronchus, larynx, or trachea), and soft-tissue sarcoma (other than osteosarcoma, chondrosarcoma, Kaposi’s sarcoma, or mesothelioma). 38 U.S.C. § 1116(a)(2); 38 C.F.R. § 3.309(e). A Veteran is presumed to have been exposed to herbicides if he or she served in Vietnam between January 9, 1962, and May 7, 1975, unless there is affirmative evidence to establish that the Veteran was not exposed to any such agent during that service. 38 U.S.C. § 1116(f); 38 C.F.R. § 3.307(a)(6)(iii). The term “herbicide agent” means a chemical in an herbicide used in support of the United States and allied military operations in the Republic of Vietnam during the period beginning on January 9, 1962, and ending on May 7, 1975, specifically: 2,4-D; 2,4,5-T and its contaminant TCDD; cacodylic acid; and picloram. 38 U.S.C. § 1116 (a)(4); 38 C.F.R. § 3.307 (a)(6)(i). The presumption of service connection requires exposure to an herbicide agent and manifestation of the disease to a degree of 10 percent or more within the time period specified for each disease. 38 C.F.R. § 3.307(a)(6)(ii). With regard to presumptive service connection, the Veteran’s service personnel records (SPRs), including his DD Form 214, confirm that he served in the Republic of Vietnam during the Vietnam Era from August 1967 to August 1968. In addition, an August 2013 NPRC PIES response confirms that he served in Vietnam during that timeframe. Therefore, he is presumed to have been exposed to herbicides, including Agent Orange, during his active duty in Vietnam. 38 C.F.R. § 3.307(a)(6), 3.313(a). However, the Veteran’s immediate cause of death, pancreatic cancer, is not on the list of diseases associated with herbicide exposure for purposes of the presumption. 38 U.S.C. § 1116(a)(2); 38 C.F.R. § 3.309(e). Thus, he is not entitled to service connection on a presumptive basis for pancreatic cancer as discussed in 38 C.F.R. § 3.309(e). In fact, with regard to presumptive service connection, the VA Secretary, under the authority of the Agent Orange Act of 1991 and based on studies by the National Academy of Sciences (NAS), has also determined that there is no positive association between exposure to herbicides and any other condition for which the Secretary has not specifically determined a presumption of service connection is warranted. See Diseases Not Associated with Exposure to Certain Herbicide Agents, 67 Fed. Reg. 42600-42608 (June 24, 2002); 72 Fed. Reg. 32,395-407 (June 12, 2007); 74 Fed. Reg. 21,258-260 (May 7, 2009). With regard to pancreatic cancer, the NAS issued Veterans and Agent Orange: Update 2010 (Update 2010). Based on the Update and prior NAS reports, the VA Secretary specifically determined that a presumption of service connection based on exposure to herbicides is not warranted for pancreatic cancer in particular. See 77 Fed. Reg. 155 (August 10, 2012). The VA Secretary found inadequate or insufficient evidence to determine whether an association exists between herbicide exposure and pancreatic cancer. That is, taking account of the available evidence and the NAS analysis, the VA Secretary has found that the credible evidence against an association between herbicide exposure and pancreatic cancer outweighs the credible evidence for such an association, such that he has determined that a positive association does not exist. However, this does not preclude the appellant from establishing entitlement to service connection for the Veteran’s pancreatic cancer with proof of actual direct causation. Combee, 34 F.3d at 1043. That is, if the claimed disease is not one of the presumptive diseases listed in 38 C.F.R. § 3.309(e), but exposure to an herbicide is presumed or proven by the evidence, as is the case here, the appellant may still establish service connection for the disease by (1) showing that the Veteran’s pancreatic cancer actually began during service; or (2) by submitting evidence of a nexus between the Veteran’s pancreatic cancer and his exposure to herbicides during military service. Combee, 34 F.3d at 1043-1044. In fact, the Court has specifically held that the provisions set forth in Combee, which, instead, concerned exposure to radiation, are nonetheless applicable in cases, as here, involving exposure to Agent Orange. Stefl v. Nicholson, 21 Vet. App. 120 (2007); McCartt v. West, 12 Vet. App. 164, 167 (1999). With regard to direct service connection, the Veteran’s service treatment records (STRs) dated from 1966 to 1968 are negative for any complaints, treatment, or diagnosis of pancreatic cancer. Neither the Veteran nor the appellant has alleged in-service symptoms or treatment for pancreatic cancer. In addition, the Veteran’s STRs and SPRs fail to document that he contracted malaria during active duty, as the appellant has contended. Thus, the Veteran’s STRs provide no evidence in support of the claim. Post-service, there is no probative evidence of a malignant tumor from pancreatic cancer at a 10 percent level within one year after service in 1969. Thus, the Veteran is not entitled to service connection for pancreatic cancer on a presumptive basis. 38 U.S.C. §§ 1101, 1112, 1113; 38 C.F.R. §§ 3.307(a)(3), 3.309(a); Walker, 708 F.3d 1335-37. Post-service, under 38 C.F.R. § 3.303(b), the evidence of record does not establish continuity of symptomatology for any pancreatic cancer after discharge from active service in 1968, in lieu of a medical nexus. Neither the Veteran nor the appellant ever specifically alleged continuity of symptomatology for pancreatic cancer. The Board is cognizant that symptoms, not treatment, are the essence of continuity of symptomatology. See Cartright v. Derwinski, 2 Vet. App. 24, 26 (1991). In fact, the first symptoms of pancreatic cancer reported in the claims file are from 2009, which is approximately 41 years after separation from service. See January 2010 Heartland Dallas Hospice Services comprehensive nursing assessment (Veteran has experienced weight loss of 35 pounds for the past 2-3 months); January 8, 2010 VA nursing ER triage note (Veteran presents to the ER with jaundice, loss of appetite, nausea, weight loss, weakness, and abdominal discomfort for the past month); January 9, 2010 VA History and Physical note (Veteran with no significant past medical history or medical visits presents with one-month history of jaundice and decreased appetite – he was noted to be doing well until about six weeks ago, when he started having weight loss of approximately 35 pounds, decreased appetite, and yellowish discoloration of his skin); January 11, 2010 VA gastroenterology consult (one-month history of decreased appetite, jaundice, weight loss over 30 pounds the past six weeks); and January 14, 2010 VA surgery consult (weight loss for six weeks, one-month history of jaundice and decreased appetite – due to pancreatic carcinoma). Post-service, in light of the above evidence, the first symptoms of pancreatic cancer began approximately 41 years after separation from service. The mere absence of medical records does not contradict a Veteran’s statements about his symptom history. See Buchanan v. Nicholson, 451 F.3d 1331, 1336 (Fed. Cir. 2006). But, here, the Veteran and the appellant’s description of the Veteran’s symptom history is consistent with what the clinical evidence of record describes. If it determined based upon reliable evidence that there was an extended period of time after service without any manifestations of the claimed condition, then that tends to weigh against a finding of a connection between the disability and service. See Maxson v. Gober, 230 F.3d 1330, 1333 (Fed. Cir. 2000). In summary, this long period without pancreatic symptoms weighs against the cause of death claim. With regard to a nexus, there is no probative evidence of record establishing a relationship between the Veteran’s cause of death from pancreatic cancer and his period of active service from 1966 to 1968. Holton, 557 F.3d at 1366. See also 38 C.F.R. § 3.303(a), (d). Absent such evidence of a nexus, service connection is not in order for the Veteran’s immediate cause of death from pancreatic cancer. In fact, there is probative medical evidence of record that clearly weighs against a relationship between the Veteran’s immediate cause of death from pancreatic cancer with his presumed herbicide exposure from his period of military service. In this regard, the RO has secured a January 2019 VA medical opinion from a VA staff physician, in accordance with development requested by the Board. This VA staff physician reviewed the claims file. He issued three conclusions: (a) The non-presumptive pancreatic cancer (which caused the Veteran’s death) less likely as not (less than 50 percent probability) began in-service or was otherwise causally related to his conceded in-service Vietnam herbicide exposure during the Vietnam War (even though pancreatic cancer is not presumptively related to herbicide exposure). (b) Service connection on a direct basis is less likely as not warranted for the Veteran’s pancreatic cancer. (c) The Veteran’s cause of death (pancreatic cancer) is less likely as not (less than 50 percent probability) related to malaria he may have contracted during service in Vietnam. The January 2019 VA staff physician acknowledged the appellant’s lay assertions and reported history – that is, her October 2016 testimony that she was told by a VA doctor in 2010 that the Veteran’s cause of death from pancreatic cancer “could be” due to his Agent Orange exposure in Vietnam in the 1960s. But the January 2019 VA staff physician reasoned that the appellant’s testimony does not provide a causal connection between herbicide exposure and this Veteran’s diagnosed pancreatic cancer. No rationale was provided for the VA doctor’s 2010 statement on this issue. Moreover, this statement is not documented in the probative evidence of record. This statement does not provide a 50/50 or greater causal connection between herbicide exposure and this Veteran’s diagnosed pancreatic cancer, according to the January 2019 VA staff physician. In addition, the January 2019 VA staff physician discussed the appellant’s testimony that the Veteran contracted malaria in Vietnam, implying that malaria may also be causal for his pancreatic cancer. But the VA staff physician concluded no probative evidence to support this assertion is found in the electronic claims file. He added the weight of current medical evidence does not support this contention. The Board finds that this conclusion from the VA staff physician is supported by the absence of any mention in the Veteran’s STR, SPRs, or post-service clinical evidence of record for any contraction of malaria. In any event, the Board observes that the January 2019 VA staff physician correctly considered and addressed the appellant’s lay assertions regarding the etiology of the Veteran’s pancreatic cancer. See Dalton v. Nicholson, 21 Vet. App. 23, 39-40 (2007). The January 2019 VA staff physician also surmised that the available epidemiologic studies are not of insufficient quality, consistency, or statistical power to support a causal connection between Agent Orange and pancreatic cancer. Current studies fail to control for confounding, have inadequate exposure assessment, or fail to address latency. There is inadequate or insufficient evidence to support a causal association between exposures to herbicides (such as Agent Orange) and the health outcome of colon or rectal cancer according to the NAS. The VA staff physician referenced a recent update from 2018 – “National Academies of Sciences, Engineering, and Medicine 2018. Veterans and Agent Orange: Update 11 (2018). Washington, DC: The National Academies Press.” The Board finds that the January 2019 VA staff physician opinion was thorough, supported by an explanation, based on a review of the claims folder, and supported by the Veteran’s in-service and post-service medical records. The other probative evidence of record does not conflict with this evidence. The Board acknowledges that in January 2010, two months prior to his death, the appellant maintains that one of the Veteran’s physicians advised the appellant that the Veteran’s pancreatic cancer “could be” due to his in-service Agent Orange exposure. The Board has carefully reviewed the Veteran’s VA treatment records dated in 2010 and his private Heartland Dallas Hospice Services records dated from January 2010 to March 2010. But there is no written documentation of such an opinion being rendered. In any event, the Court has clarified in Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007) that lay evidence regarding what a medical professional told a lay person is specifically listed as an example of competent lay testimony. Therefore, the Board will consider this evidence, as the appellant is competent to state what medical personnel told her orally in January 2010. Nonetheless, the Court has held that neither a VA medical examination report nor a private medical opinion is entitled to any weight in a service-connection context if it contains only a conclusion without reasoning or rationale. Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008). The appellant never described any rationale being provided in January 2010 by one of the Veteran’s physicians who advised the appellant that the Veteran’s pancreatic cancer “could be” due to his in-service Agent Orange exposure. The Court has also held that the use of the term “could,” without other rationale or supporting data, is speculative. Bloom v. West, 12 Vet. App. 185 (1999). Although this purported opinion in January 2010 by one of the Veteran’s physicians remains competent and probative, if the question of etiology cannot be determined without resorting to speculation, then it has not been proven to the level of equipoise. Chotta v. Peake, 22 Vet. App. 80, 86 (2008) (Board may not award benefits when the award would be based upon pure speculation). In any event, the January 2019 VA staff physician opinion discussed above is more detailed and probative than any medical opinion conveyed orally to the appellant in January 2010. That is, the January 2019 VA staff physician opinion is based on a review of the claims file, including the appellant’s lay statements, as well as on the clinician’s medical expertise. Although not by any means perfect, it is also supported by an adequate and detailed rationale, as well as by the other clinical evidence of record. On the other hand, the appellant’s recitation of what a doctor told her in January 2010 does not reveal the basis or rationale for such an opinion. With regard to lay evidence of a nexus between the Veteran’s pancreatic cancer (his cause of death) to service, lay persons are not categorically incompetent to speak on matters of medical diagnosis or etiology. Davidson v. Shinseki, 581 F.3d 1313, 1316 (Fed. Cir. 2009). The Veteran and the appellant are competent to report purported any symptoms of his pancreatic cancer during and after service. See 38 C.F.R. § 3.159(a)(2); Barr, 21 Vet. App. at 307-09. However, in the present case, neither the Veteran nor the appellant has made any specific allegation of in-service pancreatic symptoms or ongoing symptoms immediately after service. The Board has found the appellant’s lay assertions regarding the etiology of the Veteran’s pancreatic cancer to be less persuasive than the post-service medical evidence of record. Stated another way, the appellant’s lay assertions in the present case are outweighed by the clinical findings of the January 2019 VA staff physician opinion, who determined that the Veteran’s cause of death due to pancreatic cancer is not related to his Agent Orange exposure during military service decades earlier. The Board can favor competent medical evidence over lay statements offered by the Veteran, as long as the Board neither deems lay evidence categorically incompetent nor improperly requires a medical opinion as the sole way to prove causation. King v. Shinseki, 700 F.3d 1339, 1344 (2012). In this case, the January 2019 VA staff physician reviewed and considered the evidence of record, including the appellant’s lay statements, and provided a medical opinion with a supporting rationale relying on medical training, knowledge, and expertise. Moreover, no medical professional of record has submitted a written opinion with a rationale indicating that presumed Agent Orange exposure during service caused the Veteran’s pancreatic cancer, from which he died. Finally, the Board has considered the appellant’s recent March 2018 statement asserting the Veteran also had a diagnosis of diabetes during his January 2010 to March 2010 hospitalization prior to his death. She adds that the Veteran was provided insulin at the VAMC in Dallas, in order to treat his diabetes. In this regard, the Board is aware that the list of diseases associated with herbicide exposure for purposes of the presumption include Type II diabetes mellitus. 38 U.S.C. § 1116(a)(2); 38 C.F.R. § 3.309(e). VA inpatient medication records dated in January 2010 confirm that the Veteran was provided insulin. It was noted to be necessary for “adequate glucose control.” This fact is undisputed by the Board. Regardless, a review of the Veteran’s VA treatment records dated in 2010 and his private Heartland Dallas Hospice Services records dated from January 2010 to March 2010 fail to reveal any diagnosis of type II diabetes mellitus for the Veteran. On its own accord, the RO secured a February 2019 VA medical opinion from a VA staff physician to address the Veteran’s use of insulin prior to his death. The claims file was reviewed. The VA staff physician wrote that the appellant contends the Veteran had diabetes mellitus prior to his death, and this condition contributed to his death. That notwithstanding, the February 2019 VA staff physician concluded that the Veteran did not have Type II diabetes prior to his death. The Veteran did have elevated blood sugar (BS) with an IV in place with dextrose in the IV. But this was because he was suffering from pancreatic cancer which was replacing the pancreatic tissue. He was therefore prescribed Megace (megestrol acetate) to improve his appetite, which may increase blood sugar. Significantly, when his Megace and IV were stopped, the Veteran did not have blood sugar which would be consistent with diabetes. As such, the February 2019 VA staff physician concluded the Veteran did not have type II diabetes mellitus prior to his death, and therefore, it could not have contributed to his death. The Board finds this VA medical opinion is strongly supported by the Veteran’s VA treatment records dated in 2010 and his private Heartland Dallas Hospice Services records dated from January 2010 to March 2010. These clinical records fail to reveal any diagnosis of type II diabetes mellitus for the Veteran. Contemporaneous medical findings have greater probative value than history as reported by the claimant at a later time. Curry v. Brown, 7 Vet. App. 59, 68 (1994). Accordingly, the preponderance of the evidence is against service connection for the cause of the Veteran’s death. Thus, there is no reasonable doubt to resolve in the appellant’s favor. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102. DAVID L. WIGHT Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board P.S. Rubin, 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.