Citation Nr: 19166407 Decision Date: 08/27/19 Archive Date: 08/27/19 DOCKET NO. 19-05 706 DATE: August 27, 2019 ORDER Entitlement to service connection for diffuse large B-cell lymphoma on a substitution basis is denied. FINDING OF FACT Diffuse large B-cell lymphoma was not manifested during active service or for many years thereafter, and was not otherwise causally related to active service, to include alleged exposure to asbestos, chemicals, and/or pesticides. CONCLUSION OF LAW The criteria for service connection for diffuse large B-cell lymphoma on a substitution basis are not met. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. §§ 3.102, 3.303. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from August 1977 to March 1978 and from June 1979 to November 2000. The Veteran died in May 2018. The appellant is the Veteran’s surviving spouse. This case is before the Board of Veterans’ Appeals (Board) on appeal from a November 2018 rating decision. 1. Entitlement to service connection for diffuse large B-cell lymphoma. The appellant contends that the Veteran’s diffuse B-cell lymphoma was caused by exposure to asbestos and chemicals while serving in Bosnia, as well as, chemicals and/or pesticides on field trainings during active military service. 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. 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). The question for the Board is whether the Veteran has a current disability that began during service or is at least as likely as not related to an in-service injury, event, or disease. The Board concludes that, while the Veteran has a diagnosis of diffuse large B-cell lymphoma, the preponderance of the evidence is against finding that it began during active service, or is otherwise related to an in-service injury, event, or disease. In this regard, the Veteran’s service treatment records do not show that the Veteran sought treatment for symptoms of or was diagnosed with diffuse large B-cell lymphoma during active military service. In fact, the medical evidence of record shows that the Veteran was first diagnosed with large B-cell carcinoma in July 2015. With respect to the appellant’s assertion that the Veteran was exposed to asbestos while serving in Bosnia, such claim must be analyzed under VA administrative protocols. See Ennis v Brown, 4 Vet. App. 523 (1993), McGinty v. Brown, 4 Vet. App. 428 (1993). Although there is no specific statutory or regulatory guidance regarding claims for residuals of asbestos exposure, VA has several guidelines for Regional Offices to follow when dealing with compensation claims based on asbestos exposure. VBA Adjudication Procedure Manual M21-1, part IV, Subpart ii, Ch 2, Section C. In this regard, the M21-1 provides the following non-exclusive list of asbestos-related diseases and/or abnormalities: fibrosis to include asbestosis, tumors, pleural effusions and fibrosis, pleural plaques, mesotheliomas of pleura and peritoneum, lung cancer, bronchial cancer, cancer of the larynx, cancer of the pharynx, cancer of the urogenital system (except the prostate), and cancers of the gastrointestinal tract. See M21-1, part IV, Subpart ii, Chapter 2, Section C, 2(b). The M21-1 also provides the following non-exclusive list of occupations that have higher incidents of asbestos exposure: mining, milling, work in shipyards, insulation work, demolition of old buildings, carpentry and construction, manufacture and servicing of friction products such as clutch facings and brake linings, and manufacture and installation of roofing and flooring materials, asbestos cement sheet and pipe products, and military equipment. See M21-1, part IV, Subpart ii, Chapter 2, Section C, 2(d). The M21-1 provides that a clinical diagnosis of asbestosis requires a history of exposure and radiographic evidence of parenchymal lung disease. Diagnostic indicators include dyspnea on exertion, end-respiratory rales over the lower lobes, compensatory emphysema, clubbing of the fingers at late stages, and pulmonary function impairment and cor pulmonale that can be demonstrated by instrumental methods. See M21-1, part IV, Subpart ii, Chapter 2, Section C, 2(g). The Board is not bound by the M21-1, but it is acknowledged that the RO considered this guidance when it issued the rating decision on appeal. Additionally, the Board should consider whether military records demonstrate evidence of asbestos exposure during service, whether there was pre-service, post-service, occupational, or other asbestos exposure, and whether there is a relationship between asbestos exposure and the claimed disease. After careful review of the record, the Board finds that it was not likely that the Veteran was exposed to asbestos during active military service. In this regard, there is nothing in his service records that indicates the Veteran was exposed to asbestos. His military occupational specialty during service was voice intercept tech. The Veteran’s service personnel records reflect that while he was stationed in Bosnia his duty was officer in charge of Trojan Spirit II (military intelligence satellite communication system). There is no indication based on his military occupational specialty or with consideration of the places, types, and circumstances of the Veteran’s service that he was exposed to asbestos. Furthermore, the claims file does not contain any competent medical evidence or opinion that indicates that the Veteran’s diffuse B-cell lymphoma was caused by or related to active military service to include the alleged exposure to asbestos, chemicals, and/or pesticides. Although the appellant sincerely believes that the Veteran’s diffuse B-cell lymphoma was due to active military service to include the alleged exposure to asbestos, chemicals, and/or pesticides, she is not competent to provide a medical opinion in this case. The diagnosis and etiology of diffuse B-cell lymphoma cannot be competently addressed by the Appellant as a lay person based on personal observation, such as, visual observation or by any other senses. This issue is medically complex, as it requires knowledge of interpreting complicated diagnostic medical testing and interpretation of medical records and studies. See Jandreau v. Nicholson, 492 F.3d 1372, 1377 n.4 (Fed. Cir. 2007). (Continued on the next page)   In conclusion, the Board finds that the evidence of record indicates that the Veteran’s diffuse B-cell lymphoma is unrelated to his active military service to include the alleged exposure to asbestos, chemicals, and/or pesticides. As the preponderance of the evidence is against the claim, the benefit of the doubt doctrine is not applicable. Accordingly, entitlement to service connection for diffuse B-cell lymphoma is not warranted. L. B. CRYAN Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board B. Berry, 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.