Citation Nr: 19173282 Decision Date: 09/19/19 Archive Date: 09/19/19 DOCKET NO. 11-23 085 DATE: September 19, 2019 ORDER Entitlement to service connection for esophageal cancer, to include as due to Agent Orange exposure and/or asbestos exposure, is denied. Entitlement to service connection for chronic bronchitis, to include as due to Agent Orange exposure and/or asbestos exposure, or as secondary to esophageal cancer, is denied. Entitlement to service connection for gastroesophageal reflux disease (GERD), as secondary to residuals of the esophageal cancer treatment, is denied. FINDINGS OF FACT 1. The Veteran’s esophageal cancer did not begin during and was not otherwise caused by his military service, including exposure to Agent Orange and/or asbestos exposure. 2. The Veteran’s chronic bronchitis did not begin during and was not otherwise caused by his military service, including exposure to Agent Orange and/or asbestos exposure; but may be attributable to his esophageal cancer, which is not service connected. 3. The Veteran’s GERD did not begin during and was not otherwise caused by his military service, and his esophageal cancer is not service-connected. CONCLUSIONS OF LAW 1. The criteria for entitlement to service connection for esophageal cancer, to include as due to Agent Orange and/or asbestos exposure, are not met. 38 U.S.C. §§ 1101, 1112, 1113, 1116, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309. 2. The criteria for entitlement to service connection for chronic bronchitis, to include as due to Agent Orange and/or asbestos exposure, or as secondary to esophageal cancer treatments, are not met. 38 U.S.C. §§ 1101, 1112, 1113, 1116, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.310, 3.307, 3.309. 3. The criteria for secondary service connection for GERD as due to residuals for esophageal cancer treatments have not been met. 38 U.S.C. §§ 1154; 38 C.F.R. §§ 3.102, 3.310. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from October 1967 to June 1969. This matter comes before the Board of Veterans’ Appeals (Board) from an August 2010 rating decision issued by a Regional Office (RO) of the United States Department of Veteran Affairs (VA). The Veteran and his wife provided sworn testimony in support of his appeal in a July 2014 hearing before the undersigned Veterans Law Judge (VLJ). In a February 2015 decision, the Board denied the Veteran’s claims for esophageal cancer and bronchitis, both as due to exposure to Agent Orange and/or asbestos. The Veteran timely appealed the Board’s decision to the United States Court of Appeals for Veterans Claims (CAVC). In a January 2017 memorandum decision, the Court remanded the Board’s decision, finding that the Board’s decision failed to provide an adequate statement of reasons and bases for the denial of service connection. Specifically, the Veteran’s claims for service connection for his esophageal cancer and bronchitis, to include as due to exposure to Agent Orange and/or asbestos, were remanded by CAVC after it was found the Board’s decision relied on the 2014 medical examination that was found to have several issues the Board failed to discuss. The Court found the Board’s failure to remand for clarification or to address the examiner’s medical qualifications rendered the Board’s statement of reasons and bases inadequate. The Board notes that in October 2015, the Veteran filed a petition to reopen after the Board’s denial of the Veteran’s claims in February 2015. As noted above, the Veteran filed a timely appeal to CAVC and the case was fully briefed and assigned to a judge, and the Veteran’s attorney requested this reopening to be “mooted” should CAVC render a decision. See January 2017 correspondence. The petition to reopen the claim is thereby mooted as CAVC set aside the Board’s denial of his original claim and the original claim remains pending. Finally, the Board acknowledges that the increased evaluation claim for coronary artery disease is part of a different appeal stream that is currently being developed at the RO at the post-Notice of Disagreement stage. The RO has not yet issued a statement of the case regarding the claim. The Board acknowledges that ordinarily the claim should be remanded for issuance of a statement of the case pursuant to Manlincon v. West, 12 Vet. App. 238 (1999). However, the record indicates that additional action is pending at the RO such that this situation is distinguishable from Manlincon, where the NOD had not been recognized. The Veteran requested traditional appellate review on this claim, and that will be done in the ordinary course of business. As such, this issue is not ready for appellate review at this time. The Board has thoroughly reviewed all the evidence in the Veteran’s VA files. In every decision, the Board must provide a statement of the reasons or bases for its determination, adequate to enable an appellant to understand the precise basis for the Board’s decision, as well as to facilitate review by the Court. See 38 U.S.C. § 7104 (d)(1); Allday v. Brown, 7 Vet. App. 517, 527 (1995). Although the entire record must be reviewed by the Board, the Court has repeatedly found that the Board is not required to discuss, in detail, every piece of evidence. Gonzales v. West, 218 F.3d 1378, 1380-81 (Fed. Cir. 2000); Dela Cruz v. Principi, 15 Vet. App. 143, 149 (2001) (rejecting the notion that the Veterans Claims Assistance Act mandates that the Board discuss all evidence). Rather, the law requires only that the Board address its reasons for rejecting evidence favorable to the appellant. Timberlake v. Gober, 14 Vet. App. 122 (2000). The points below focus on the most salient and relevant evidence and on what this evidence shows, or fails to show, on the claim. The appellant must not assume that the Board has overlooked pieces of evidence that are not explicitly discussed herein. Timberlake, infra. As discussed more fully below, there are competing medical opinions on these issues, and the Board must weigh their evidentiary value. See Owens v. Brown, 7 Vet. App. 429, 433 (1995). The fact there are conflicting medical opinions does not automatically lead to a conclusion that there is equipoise. Mere disagreement among experts does not indicate that the evidence is in equipoise. Rather, the Board must consider several factors in determining the adequacy and probative value of a medical opinion such as the expert's knowledge and skill in analyzing the data; whether the opinion contains clear conclusions with supporting data and a reasoned medical explanation connecting the two; whether the opinion is clear and susceptible of only one meaning; the expert's familiarity with pertinent medical history; whether there is any inconsistency in the expert's statements; whether the expert has provided a thorough and detailed opinion about an area within his or her expertise; whether the expert has provided factually accurate, fully articulated, and sound reasoning for his or her conclusion; whether the expert relied on sufficient facts or data; and whether the opinion is the result of principles and methods reliably applied to facts. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008); D'Aries v. Peake, 22 Vet. App. 97, 108 (2008); Stefl v. Nicholson, 21 Vet. App. 120, 123 (2007); Daves v. Nicholson, 21 Vet. App. 46, 51-52 (2007); Guerrieri v. Brown, 4 Vet. App. 467, 470-71 (1993). Neither the Veteran nor his representative has raised any issues with the duty to notify or duty to assist. 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). Thus, the Board need not discuss any potential issues in this regard. Further, the Veteran has not alleged any deficiency with the conduct of his hearing before the undersigned as to the duties discussed in Bryant v. Shinseki, 23 Vet. App. 488, 496-97 (2010). In this regard, the Federal Circuit ruled in Dickens v. McDonald, 814 F.3d 1359 (Fed. Cir. 2016) that a Bryant hearing deficiency was subject to the doctrine of issue exhaustion as laid out in Scott v. McDonald, 789 F.3d 1375 (Fed. Cir. 2015). Thus, the Board need not discuss any potential Bryant problem because the Veteran has not raised that issue before the Board. 1. Entitlement to service connection for esophageal cancer, to include as due to exposure to Agent Orange and/or asbestos. Previously, BVA had conceded presumed herbicide exposure and the Board will not disrupt this favorable determination. However, the list of diseases associated with exposure to certain herbicide agents does not include esophageal cancer. As such, presumptive service connection is not warranted. See 38 C.F.R. § 3.309(e). In this regard, the Board notes the National Academy of Sciences (NAS) in Update 11 (2018) has continued to find inadequate or insufficient evidence to determine whether an association exists between herbicide exposure and respiratory disorders, gastrointestinal and digestive disease, to include esophageal and stomach cancers. Notwithstanding the presumptive provisions, the United States Court of Appeals for the Federal Circuit (Federal Circuit) has determined that the Dioxin and Radiation Exposure Compensation Standards Act does not preclude a claimant from establishing service connection with proof of actual direct causation. Combee v. Brown, 34 F.3d 1039, 1042 (Fed. Cir. 1994). Therefore, the question in front of the Board is whether the Veteran’s esophageal cancer may be service-connected on a direct basis. Service connection may be established for disability resulting from personal injury suffered or disease contracted in the line of duty in the active military, naval, or air service. See 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303. In order to prevail on the issue of service connection there must be competent evidence of a current disability; medical evidence, or in certain circumstances, lay evidence of in-service occurrence or aggravation of a disease or injury; and competent evidence of a nexus between an in-service injury or disease and the current disability. Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004); Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007). Here, it is not in dispute that the Veteran was diagnosed with esophageal cancer in 2004 and had residual cancer treatment. As noted above, it is also not in dispute that the Veteran was exposed to herbicides. The Board further notes that the Veteran’s military occupational specialty (MOS) was a turret gunner. The Board in the 2015 decision conceded he was exposed to asbestos while in service. A nexus showing that exposure caused his esophageal cancer is therefore needed. In this case, there are several conflicting nexus opinions. First, the Veteran submitted a statement from Dr. C.E., a surgeon, in February 2010, who opined that he “cannot state [the Veteran’s] diagnosis is related to Agent Orange exposure. More importantly, I cannot with any certainty state that it is not related.” The Board finds this opinion to be conclusory and not probative in value. Thereafter, the Board sought out an independent medical opinion (IMO); although CAVC noted this opinion was inadequate, it was referenced several times in subsequent positive and negative nexus opinions, and the Board has considered the opinion and statements from Dr. H.H. in relation to those later relevant opinions. For instance, the December 2014 medical opinion concluded that it was less than a 50 percent probability the Veteran’s esophageal cancer was due to the presumed asbestos and Agent Orange exposure in service. Dr. H.H. included various causes and medical literature concerning esophageal cancer that did not show exposure to Agent Orange or asbestos. She also stated that risk factors included endoscopy and biopsy of Barrett’s esophagus, which is considered pre-malignant and is directly the result of chronic or poorly controlled reflux, which causes malignant transformation of the cells in the esophagus. Further, Dr. H.H. noted that the Veteran was obese at the time of his diagnosis, which is also a risk factor for adenocarcinoma of the esophagus. In response, the Veteran submitted in November 2017 a statement from a private doctor, Dr. D.R., who opined that based on a review of the claims file, and his professional education, training, and experience, and after a review of relevant scientific literature, the Veteran’s esophageal cancer was as likely as not causally related to his exposure to asbestos during his active duty and his exposure to herbicides during his active duty service in Vietnam. His rationale was he assumed the Veteran’s herbicide exposure included Agents Orange, Blue, and White, and assumed VA recognizes that one component of the herbicides to which the Veteran was exposed included arsenic, stating that “it appears published literature identifies Agent Blue as definitely containing arsenic, whereas the arsenic content of Agent Orange is less clear.” (emphasis added). This opinion, although extensive, cited to studies discussing that dioxins from herbicides may increase the risk of cancers, including esophageal cancer (emphasis added), and Dr. D.R. also stated, based on review of these studies, that they indicated a risk of development of cancerous illness as a consequence of exposure to from service. Further, Dr. D.R. stated “it is not clinically possible to determine if one particular risk factor was the sole cause of his esophageal cancer to the elimination of another as a causal factor, and assuming smoking and herbicide exposure both contributed to the eventual onset of esophageal cancer, it is not clinically possible to separate the effects of one causal agent from the other.” In May 2018, the VA requested another IMO from Dr. M.K., who opined that it was less likely as not that the Veteran’s herbicide exposure, along with asbestos exposure, contributed to his esophageal cancer, and that he had two major risk factors – smoking history and his body weight. Dr. M.K. discussed the private opinion of Dr. D.R. and stated his study regarding mortality rates of chemical workers exposed to dioxins also pointed to other factors involved apart from herbicide exposure, age, and smoking history, and noted that the mortality data does not apply to the Veteran as he is still alive more than 10 years post his primary diagnosis. Dr. M.K further discussed the cohort study of Agent Orange exposure cancer incidences, and stated that factors such as smoking history, alcohol consumption and body mass index were not considered. Finally, Dr. M.K. stated the third article submitted by Dr. D.R. regarding occupational asbestos exposure and gastrointestinal tract tumors showed an association of esophageal cancer for those with prolonged exposure of 10 or more years – here the Veteran had only been exposed for no more than 18 months. In an addendum opinion in June 2018, Dr. M.K. stated major risk factors for the development of esophageal cancer included esophageal reflux disease, Barrett’s Esophagus, tobacco use, and obesity, of which the Veteran had two of the major risk factors for the development of esophageal adenocarcinoma. Dr. M.K. further stated that Dr. D.R.’s statement of it not being clinically possibly to separate the effects of one causal agent to the other is not applicable as there is no consensus to recognize herbicides and asbestos exposure as major risk factors in the development of esophageal cancer (emphasis added). Finally, in July 2019, the Veteran responded to Dr M.K.’s IMO stating that Dr. M.K. did not enclose the full study on which she based her opinion; that one study contradicted her “no-increase” interpretation between esophageal cancer and asbestos; and the third study Dr. M.K. cited was later updated, and the committee concluded that there was not enough evidence to sustain a negative conclusion of no association with exposed to herbicides and esophageal cancer. The Veteran thereby included additional treatise evidence showing that another type of pentachlorophenol – stating this was in the same class as Agent Orange – found in China was associated with more than double the risk of esophageal cancer, and discussed another article from an Asian Pacific Journal of Cancer Prevention that demonstrated significant increase in the incidence of esophageal cancer in the population exposed to pentachlorophenol. The Veteran also asserted that his exposure 24/7 to asbestos while in Vietnam equated to four years of a civilian being exposed to asbestos in a factory like setting, elongating his exposure to more than the time period discussed by Dr. M.K. The Veteran has argued that Dr. D.R.’s statement and acknowledgement that herbicide exposure and/or asbestos exposure may increase the risk of developing esophageal cancer warrants the grant of service connection in this case. See July 2019 statement. However, VA expert opinions indicated there was no link in this case and, in any case, Dr. D.R.’s statement is insufficiently definite to meet the evidentiary standard required. Bloom v. West, 12 Vet. App. 185, 187 (1999) (“By using the term ‘may,’ without supporting clinical data or other rationale, [the expert’s] opinion simply is too speculative to provide the degree of certainty for medical nexus evidence.”). The fact that there is an increased risk does not equate to causation, and, in fact, Dr. D.R. never stated that there is a direct cause, but rather continuously pointed to studies that showed there being a possible association and an increased risk. There also was no discussion as to the Veteran’s obesity being a major risk factor, as indicated by both Dr. H.H in 2014 and Dr. M.K. in 2018. Further, the Board acknowledges that the Veteran has also submitted voluminous research regarding the possibility of herbicide exposure and asbestos exposure being associated with the development of many types of cancers, including esophageal. These articles establish that a link is medically possible, but not that this Veteran’s esophageal cancer is more likely than not etiologically related to his military service. Sacks v. West, 11 Vet. App. 314, 316-17 (1998) (holding that information contained within treatises is generally too abstract to prove the nexus element of a service-connection claim, although it is possible that a treatise might “discuss generic relationships with a degree of certainty” that would allow a finding of “plausible causality based upon objective facts.”); Colvin v. Derwinski, 1 Vet. App. 171, 174 (1991) (Board may not make independent medical assessments). While, again, the articles indicate military personnel with exposure to herbicides and/or asbestos have an increased risk of developing different types of cancer, none of the articles, nor all of the articles collectively, establish that this Veteran’s esophageal cancer is more likely than not related to his military service. These articles do more than establish some general principles, but it is the medical opinions that look at the Veteran’s specific medical history, to include his specific risk factors, that carry far more evidentiary weight. In summary, while there is a possibility that exposure to herbicides and/or asbestos may create an increased risk of cancer, the probability was less likely than not (that is, less than 50 percent) that such exposures caused the esophageal cancer. As the NAS updated report in November 2018 provided, evidence and studies were deemed inadequate or insufficient to determine whether an association exists between herbicide exposure and the Veteran’s condition. This category of association means that available epidemiologic studies are of insufficient quality, consistency, or statistical power to permit a conclusion regarding the presence or absence of an association. The Board again notes that although the extensive opinions and articles submitted by the Veteran show that there may be an association or an increased risk, an increased risk does not equate to causation. The Board is not citing to the NAS report as the sole reason for denying the claim – again, direct service connection is being considered. Rather, the NAS report’s conclusion as to the general consensus supports the negative opinions in the case, and those opinions specifically consider the Veteran’s medical situation. The Board disagrees with the Veteran’s assertion that the negative VA IMO is inadequate, and that the Secretary needs to prove by preponderance of the evidence that the Veteran’s esophageal cancer is not related to his active duty exposure to herbicides and asbestos. That is not VA’s burden of proof, and the VA expert opinion clearly states it was “less likely” in this case that such a relationship existed, and further provided alternative etiologies. In reaching this decision, the Board considered the doctrine of reasonable doubt. However, the preponderance of the evidence is against the claim, the benefit of the doubt doctrine does not apply and the claim is denied. See 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102; Gilbert v. Derwinski, 1 Vet. App. 49, 53 (1990). 2. Entitlement to service connection for chronic bronchitis, to include as due to exposure to Agent Orange and/or asbestos; or in the alternative, as secondary to treatment for the Veteran’s esophageal cancer The Veteran asserts that he also has chronic bronchitis, to include as due to exposure to Agent Orange and/or asbestos; or in the alternative, as secondary to his esophageal cancer treatments. Bronchitis is not a listed disease subject to presumptive service connection based on herbicide exposure, and there is no indication that the Veteran has or ever had the listed disease of respiratory cancer. Consequently, he is not entitled to a grant of service connection for bronchitis pursuant to herbicide presumptive provisions. See 38 U.S.C. § 1116; 38 C.F.R. §§ 3.307, 3.309. When a Veteran is found not to be entitled to a regulatory presumption of service connection for a given disability, the claim must nevertheless be reviewed to determine whether service connection can be established on another basis. Combee, 34 F.3d 1039, 1043-1044. The Board now turns to whether service connection for bronchitis is warranted on a direct basis. 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. As noted above, asbestos exposure in service was reasonably conceded in the 2015 Board decision based on the record. The Board concludes that, while the Veteran has a current diagnosis of chronic bronchitis, and evidence shows probable asbestos exposure occurred, the preponderance of the evidence weighs against finding that the Veteran’s diagnosis of bronchitis began during service or is otherwise related to an in-service injury, event, or disease, including herbicide and/or asbestos exposure. Service treatment records are negative for any complaints or findings of bronchitis. During service, the Veteran sought treatment for colds. December 1968 treatment records contained a physical evaluation for chest congestion and dry cough, and chest sounds were described as clear. In June 1969, on separation, clinical evaluations of the lungs and chest were normal. In favor of the claim, in March 2010, the Veteran’s private doctor, Dr. M.C., stated the Veteran’s chronic bronchitis is related to his exposure to Agent Orange in service, as he is not a smoker and cannot find other causes for his chronic respiratory condition. The Board finds this opinion conclusory, and inadequate as the Veteran did have a smoking history, albeit minimal. In November 2017, private doctor Dr. D.R. supported a direct service connection claim, stating that the Veteran’s chronic bronchitis /COPD is as likely as not causally related to his exposure to asbestos during active duty. He included studies that indicated an increased risk of development between COPD and other respiratory conditions such as bronchitis with the handling of man-made mineral fibers. The Veteran also testified during the 2014 Board hearing that he had bronchitis years prior to his 2004 diagnosis; supplied medical records from 1998 through 2002 showing bilateral bronchitis and complaints of a hacking and severe cough; and provided a November 2017 lay statement from his wife and himself that his smoking history was minimal and he did not smoke again after returning from Vietnam. Evidence weighing against the claim includes the aforementioned December 2014 VA medical opinion which concluded that it was less than a 50 percent probability the Veteran’s chronic bronchitis is due to the presumed asbestos and Agent Orange exposures in service. Dr. H.H. included various causes and medical literature that did not show exposure to Agent Orange being a risk factor for development for chronic bronchitis decades later. As to asbestos exposure, she stated that while the effect of asbestos on the lungs is well-known and while a chronic cough could be attributed to this, the Veteran does not have the characteristic changes in his chest X-rays nor has he been diagnosed with asbestosis, and she referenced a smoking history which may result in an increased risk of at least mild lung disease, albeit the smoking history being unimpressive. She also referenced that the Veteran’s GERD likely was a factor in his chronic cough and bronchial condition, and that surgical intervention for the Veteran’s cancer likely led to a post-surgical worsening of the GERD. She stated that GERD is a common but commonly overlooked cause for chronic cough and opined this was likely the cause of his condition. In an August 2018 VHA opinion, Dr. K.C. found no direct connection to service as there were no symptoms, complaints or diagnosis in the Veteran’s service treatment records, and opined that “it is not as least as likely as not that the Veteran’s chronic bronchitis and/or COPD were caused by asbestos or herbicide agent exposure in the Republic of Vietnam, or that they were otherwise a result of the Veteran’s active duty services.” He also opined, based on review of Dr. D.R.’s and other medical literature, that as to Agent Orange and/or asbestos exposure: “even if it is possible that the patient’s exposure history has played a role in the development of chronic bronchitis the effect is likely to be small.” He stated that Dr. D.R.’s study of occupational exposure and risk of COPD was questionable since the biological effect did not appear to be reasoned when comparing those with low mineral dust exposure and an increased incidence of COPD as opposed to those with high exposure and no increased incident. Further, he provided additional medical literature that showed no significant association and opined that “it is clinically most likely that this has developed or has been exacerbated by chronic GERD in this patient with previous esophageal cancer.” In November 2018, the Veteran submitted a follow up statement from Dr. D.R. as to asbestos exposure and respiratory conditions, noting an abstract study of exposure to asbestos showed a higher prevalence for respiratory symptoms compared to nonsmokers and smokers. He also stated that a relationship is a significant finding and “highly unlikely due to a chance occurrence.” However, the abstract indicated length of employment was a factor, and that development of chronic cough/bronchitis is likely an unspecific effect of exposure rather than a specific effect In addition, in July 2019 the Veteran stated that the VA medical expert opinion did not provide support for the denial of service connection, but that statement is simply untrue. Here, the VA medical expert provided a counter to the Veteran’s statements, the private medical opinion, and treatise evidence, as well as opined it was clinically most likely that the respiratory condition developed or was exacerbated by the chronic GERD with previous esophageal cancer – providing an alternative etiology for the condition. Although there are conflicting medical opinions, the preponderance of the evidence is against finding that exposure to herbicides causes respiratory conditions. Further, by the Veteran’s own admission, his chronic cough and bronchitis did not begin until decades after service, with the first medical record showing bronchitis in 1998. While the Veteran is competent to provide statements relating to symptoms or facts of events that he has observed and is within the realm of his personal knowledge, he is not competent to establish that which would require specialized knowledge or training, such as medical expertise. Layno v. Brown, 6 Vet. App. 465, 469-470 (1994). Although lay persons are competent to provide opinions on some medical issues, see Kahana v. Shinseki, 24 Vet. App. 428, 435 (2011), the issue in this case is outside the realm of common knowledge of a lay person because it involves complex medical issues that go beyond a simple and immediately observable cause-and-effect relationship. Jandreau v. Nicholson, 492 F.3d 1372, 1377 n. 4 (Fed. Cir. 2007). The relationship between asbestos exposure and bronchitis diagnosed many years after separation from service is a complex question, not a simple one, and under the facts of this case, not a question that can be answered by a lay person. As such, the Veteran’s statements to this effect are lacking in probative value. In summary, while there is a possibility that exposure to herbicides and/or asbestos may create an increased risk of bronchitis, the probability was less likely than not (that is, less than 50 percent) as to actual causation. The Board again notes that although the opinions and articles submitted by the Veteran show that there may be an association or an increased risk, an increased risk does not equate to causation. For the reasons stated above, the Board finds that the preponderance of evidence is against the Veteran’s claim of entitlement to service connection for chronic bronchitis. Therefore, the appeal must be denied. There is no reasonable doubt to be resolved as to this issue. See 38 U.S.C. § 5107 (b); 38 C.F.R. § 3.102; Gilbert, 1 Vet. App. 49. As to a secondary service connection claim, Dr. K.C did opine that the Veteran’s “recurrent aspiration has played a role in exacerbating the [bronchitis] condition after the surgical intervention for esophageal cancer,” and Dr. D.R. does not dispute this. However, his esophageal cancer is not service-connected; therefore, service connection for respiratory condition on a secondary basis due to a residuals of esophageal cancer treatment is denied as a matter of law. See 38 C.F.R. § 3.310. 3. Entitlement to service connection for GERD, as secondary to residuals of the esophageal cancer treatment The Veteran asserts that his GERD is secondary to residuals of his esophageal cancer treatment. However, his esophageal cancer is not service-connected; therefore, service connection for GERD on a secondary basis due to a residuals of esophageal cancer treatment is denied as a matter of law. See 38 C.F.R. § 3.310. MICHELLE L. KANE Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board G. Hoy, 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.