Citation Nr: 20002115 Decision Date: 01/09/20 Archive Date: 01/09/20 DOCKET NO. 12-35 628 DATE: January 9, 2020 ORDER Entitlement to service connection for the cause of the Veteran’s death is denied. FINDING OF FACT 1. At the time of the Veteran’s death service connection was in effect for coronary artery disease, rated as 30 percent disabling; a back disability rated as 10 percent disabling; hemorrhoids rated as 10 percent disabling; and hypertension rated as noncompensable (zero percent). 2. The preponderance of the evidence shows that the Veteran did not set foot in the Republic of Vietnam, while in Thailand was not exposed to herbicides in and around Air Force Base perimeters, and did not have actual tactical herbicide exposure while on active duty. 3. The preponderance of the evidence shows that the Veteran did not have a diagnosis of posttraumatic stress disorder (PTSD) due to combat, fear of hostile military or terrorist activity, or a verified in-service stressor. 4. The preponderance of the evidence shows that lung cancer, glioblastoma, and other acquired psychiatric disorders, including a depressive disorder, were not present in service or until many years thereafter, they are not related to service or to an incident of service origin, and they are not caused or aggravated by a service-connected disability. 5. The preponderance of the evidence shows that a service-connected disability or a disability for which service connection was warranted caused or contributed substantially or materially to the Veteran’s death. CONCLUSION OF LAW The criteria for service connection for the cause of the Veteran’s death have not been met. 38 U.S.C. §§ 1101, 1110, 1112, 1113, 1116, 1131, 1310, 5107; 38 C.F.R. §§ 3.6, 3.102, 3.203, 3.303, 3.304, 3.307, 3.309, 3.310, 3.312. REASONS AND BASES FOR FINDINGS AND CONCLUSION The Veteran served on active duty with the United States Air Force (USAF) from June 1964 to July 1986, including service on bases in Thailand during the Vietnam War. The Veteran died in March 2009. The appellant is the Veteran’s surviving spouse. In a March 2017 decision issued by a Veterans’ Law Judge other than the undersigned, the Board of Veterans’ Appeal (Board) denied service connection for the cause of the Veteran’s death. The Veteran appealed the March 2017 decision to the United States Court of Appeals for Veterans Claims (CAVC). In an August 2018 memorandum decision, CAVC vacated and remanded the March 2017 Board decision. In April 2019, the Board remanded the appeal to obtain a needed medical opinion to comply with the concerns raised in the August 2018 memorandum decision. See Forcier v. Nicholson, 19 Vet. App. 414, 425 (2006) (holding that the duty to ensure compliance with the Court’s order extends to the terms of the agreement struck by the parties that forms the basis of the joint motion to remand); cf. McBurney v. Shinseki, 23 Vet. App. 136, 140 (2009) (Board has a duty on remand to ensure compliance with the favorable terms stated in the joint motion for remand or explain why the terms will not be fulfilled.). In disability compensation claims, the duty to obtain a medical opinion is found in 38 U.S.C. § 5103A(d). The Court of Appeals for the Federal Circuit (Federal Circuit) held in DeLaRosa v. Peake, 515 F.3d 1319, 1322 (Fed. Cir. 2008) that that standard was inapplicable to cases for dependency and indemnity compensation (DIC). Instead, the Federal Circuit held, if the Secretary is required to obtain a medical opinion in such case, the duty would come from the Secretary’s general duty to assist as provided by 38 U.S.C. § 5103A(a). Id.; see also Wood v. Peake, 520 F.3d 1345, 1349 (Fed. Cir. 2008). Subsection (a) provides that the Secretary, in all cases, “shall make reasonable efforts to assist a claimant in obtaining evidence necessary to substantiate the claimant’s claim for a benefit under a law administered by the Secretary,” unless “no reasonable possibility exists that such assistance would aid in substantiating the claim.” 38 U.S.C. § 5103A(a). Thus, relying on subsection (d) rather than subsection (a) in a duty-to-assist analysis in a DIC case will be an error. Moreover, in Wood, the Federal Circuit held that the Board’s reliance on subsection (d) to determine whether a medical opinion was required in a DIC case was not harmless, citing the “dramatically different scope” of subsections (d) and (a), and observing that the two provisions “apply wholly different and unrelated requirements.” 520 F.3d at 1349. In any event, the Board finds that the subsequent October 2019 VA medical opinion substantially complied with the August 2018 CAVC memorandum decision and Board remand because after a review of the record on appeal the examiner provided medical opinions as to whether the lung cancer and glioblastoma that caused the Veteran’s death were incurred in or caused by active service to include his possible in-service herbicide exposure and these opinions are supported by citation to evidence found in the record and controlling medical literature. See 38 U.S.C. § 5103A(d); Barr v. Nicholson, 21 Vet. App. 303 (2007); Stegall v. West, 11 Vet. App. 268 (1998); D’Aries v. Peake, 22 Vet. App. 97 (2008) (holding that only substantial, and not strict compliance with the terms of a remand request, is required); Dyment v. West, 13 Vet. App. 141, 146-47 (holding that there was no Stegall violation when the examiner made the ultimate determination required by the Board’s remand, because such determination more than substantially complied with the Board’s remand order). Entitlement to service connection for the cause of the Veteran’s death The appellant claims, in substance, that service connection is warranted for the cause of the Veteran’s death for the following reasons: (1) the lung cancer that contributed to his death was due to his in-service pulmonary function defect; (2) the lung cancer that contributed to his death was due to his herbicide exposure when he traveled TDY to the Republic of Vietnam from Thailand and/or during his service in Thailand; (3) the glioblastoma that caused his death was due to his herbicide exposure when he traveled TDY to the Republic of Vietnam from Thailand and/or during his service in Thailand; and (4) the lung cancer that contributed to his death was due to smoking which was due to an acquired psychiatric disorder, including PTSD and a depressive disorder, which was caused by his military service. As can be seen from the above, the appellant has raised several different theories of entitlement, creating a highly multifaceted situation. The Board will address each. To establish service connection for the cause of the Veteran’s death, the evidence must show that a disability which was incurred in or aggravated by active duty service either caused or contributed substantially or materially to death. In this regard, it can be either the immediate or underlying cause, or else be etiologically related. 38 U.S.C. § 1310; 38 C.F.R. § 3.312. In order to constitute the principal cause of death, the service-connected disability must be medically determined to have been one of the immediate or underlying causes of death or be etiologically related to the cause of death. 38 C.F.R. § 3.312 (b). A contributory cause of death is one not inherently related to the principal cause, but that it contributed substantially or materially; combined to cause death; or assisted in the production of death. Significantly, it is not sufficient to show that it casually shared in producing death, but rather it must be shown that there was a causal connection. 38 C.F.R. § 3.312(c)(1). Service-connected diseases or injuries involving active processes affecting vital organs are given careful consideration as a contributory cause of death, despite being unrelated to primary cause, due to debilitating effects and general impairment of health that such processes may cause. 38 C.F.R. § 3.312(c)(3). In all cases, VA must consider whether the evidence indicates that a service-connected condition was of such severity as to have a material influence in accelerating death. For example, it would not generally be reasonable to hold that a service-connected condition accelerated death unless such condition affected a vital organ and was of itself of a progressive or debilitating nature. 38 C.F.R. § 3.312(c)(4). Except as otherwise provided by law, a claimant has the responsibility to present and support a claim for benefits under the laws administered by VA. VA shall consider all information and medical and lay evidence of record. Where there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, VA shall give the benefit of the doubt to the claimant. 38 U.S.C. § 5107; 38 C.F.R. § 3.102; see also Gilbert v. Derwinski, 1 Vet. App. 49, 53 (1990). In evaluating the evidence, the Board has been charged with the duty to assess the credibility and weight given to evidence. Davidson v. Shinseki, 581 F. 3d 1313 (Fed. Cir. 2009); Jandreau v. Nicholson, 492 F. 3d 1372 (Fed. Cir. 2007). Indeed, the Court has declared that in adjudicating a claim, the Board has the responsibility to do so. Bryan v. West, 13 Vet. App. 482, 488-89 (2000). In doing so, the Board is free to favor one medical opinion over another, provided it offers an adequate basis for doing so. Owens v. Brown, 7 Vet. App. 429, 433 (1995). As an initial matter, the Board notes that at the Veteran died in in March 2009. The Veteran’s death certificate lists the immediate cause of death as glioblastoma. The record also shows the Veteran was diagnosed with lung cancer in June 2002 and was diagnosed with glioblastoma in December 2002. See June 2008 private treatment record. A December 2002 private medical record also related the Veteran’s lung cancer to his glioblastoma. According to that private physician, the Veteran’s brain “was considered to be in risk of metastatic small cell lung cancer.” Similarly, the October 2019 VA medical opinion included an opinion that the radiation used to treat the Veteran’s lung cancer caused his glioblastoma, providing some evidence against several of the theories raised above. At the time of his death, service connection was in effect for coronary artery disease, rated as 30 percent disabling; a back disability rated as 10 percent disabling; hemorrhoids rated as 10 percent disabling; and hypertension rated as noncompensable (zero percent). a. Did an already service-connected disability materially contributed to cause his death? Initially, given the fact that at the time of the Veteran’s death he was service-connected for coronary artery disease, back disability, hemorrhoids, and hypertension, the Board will first consider whether any of these disorders directly caused or contributed substantially or materially to death. 38 U.S.C. § 1310; 38 C.F.R. § 3.312. In this regard, the appellant does not claim, and the record does not show that the Veteran’s service-connected coronary artery disease, back disability, hemorrhoids, and hypertension caused the Veteran’s death nor in other way contributed to cause his death. The Board also finds that even if the appellant or her representative claimed that the Veteran’s service-connected coronary artery disease, back disability, hemorrhoids, and hypertension caused the Veteran’s death or in other way contributed to cause his death they are not competent to provide the missing nexus opinion because they do not have the required medical expertise to provide an answer to this complex medical question (i.e., what caused or contributed to cause the Veteran’s death). See Davidson, supra. Given the above record, the Board also finds that the criteria to obtain a medical opinion as to this question have not been met. See Paralyzed Veterans of America, et. al., v. Secretary of Veterans Affairs, 345 F.3d 1334 (Fed. Cir. 2003) (holding that the criteria for obtaining an etiology opinion have not been met when the evidence of record does not establish that the veteran suffered an event, injury, or disease in service because no reasonable possibility exists that providing a medical examination or obtaining a medical opinion would substantiate the claim); Duenas v. Principi, 18 Vet. App. 512, 519 (2004) (VA is not obligated to provide an examination for a medical nexus opinion where, as here, the supporting evidence of record consists only of a lay statement [at best]). Therefore, because the record does not show that the Veteran’s service-connected coronary artery disease, back disability, hemorrhoids, and hypertension had any relationship to the glioblastoma and/or lung cancer that caused or contributed to the Veteran’s death or in other way contributed to cause his death, the Board finds that the claim of service connection for the cause of the Veteran’s death cannot be granted based directly on the disabilities service connection were in affect at the time of his death. 38 U.S.C. § 1310; 38 C.F.R. § 3.312. b. During his lifetime should the Veteran have been service-connected for lung cancer, glioblastoma, and an acquired psychiatric disorder? Next, the Board will consider the appellant’s claim that the Veteran should have been service-connected for lung cancer, glioblastoma, and an acquired psychiatric disorder, including PTSD and a depressive disorder, during his lifetime and these disorders caused or contributed substantially or materially to death. 38 U.S.C. § 1310; 38 C.F.R. § 3.312. In this regard, service connection is warranted where the evidence of record establishes that a particular injury or disease resulting in disability was incurred in the line of duty in the active military service or, if pre-existing such service, was aggravated thereby. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303. If a condition noted during service is not shown to be chronic, then generally a showing of continuity of symptomatology after service is required for service connection if the disability is one that is listed in 38 C.F.R. § 3.309. 38 C.F.R. § 3.303(b); see also Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013). In addition, service connection may also be granted on the basis of a post-service initial diagnosis of a disease, where the physician relates the current condition to the period of service. 38 C.F.R. § 3.303(d). Other specifically enumerated disorders will be presumed to have been incurred in service if they manifested to a compensable degree within the first year following separation from active duty. 38 U.S.C. §§ 1101, 1112, 1113; 38 C.F.R. §§ 3.307, 3.309. To establish service connection for the claimed disorders, there must be (1) medical evidence of a current disability; (2) medical, or in certain circumstances, lay evidence of in-service incurrence or aggravation of a disease or injury; and (3) medical evidence of a nexus between the claimed in-service disease or injury and the current disability. See Hickson v. West, 12 Vet. App. 247, 253 (1999). As to herbicide exposure, VA laws and regulations provide that a Veteran who, during active military, naval, or air service, served in the Republic of Vietnam during the Vietnam war (i.e., January 9, 1962, to May 7, 1975), shall be presumed to have been exposed to an herbicide agent, unless there is affirmative evidence to the contrary. 38 U.S.C. § 1116(a)(3); 38 C.F.R. § 3.307(a)(6)(iii). The last date on which such a Veteran shall be presumed to have been exposed to an herbicide agent shall be the last date on which he served in the Republic of Vietnam during the Vietnam war period. 38 C.F.R. § 3.307. For these Vietnam Veterans, diseases associated with exposure to certain herbicide agents will be presumed to have been incurred in service even though there is no evidence of that disease during the period of service at issue. 38 U.S.C. § 1116; 38 C.F.R. §§ 3.307, 3.309. Effective February 24, 2011, VA amended its adjudication regulations to extend a presumption of herbicide exposure to certain Veterans who served in Korea. Specifically, a veteran who, during active military, naval, or air service, served between April 1, 1968, and August 31, 1971, in a unit that, as determined by the Department of Defense (DoD), operated in or near the Korean demilitarized zone (DMZ) in an area in which herbicides are known to have been applied during that period, shall be presumed to have been exposed during such service 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)(iv). As to herbicide exposure due to military service in Thailand, VA has determined that special consideration of herbicide exposure on a factual basis should be extended to veterans whose duties placed them on or near the perimeters of certain Thailand military bases where herbicide may have been sprayed. In this regard, VA in a Memorandum entitled Herbicide Use in Thailand During the Vietnam Era, reported as follows: The DoD list indicates only that limited testing of tactical herbicides was conducted in Thailand from 2 April through 8 September 1964. Specifically, the location identified was the Pranburi Military Reservation associated with the Replacement Training Center of the Royal Thai Army, near Pranburi, Thailand. The Report of these tests noted that 5 civilian and 5 military personnel from Fort Detrick, Maryland conducted the spray operations and subsequent research. This location was not near any U. S. military installation or Royal Thai Air Force Base... Tactical herbicides such as Agent Orange were used and stored in Vietnam, not Thailand... There are records indicating that commercial herbicides were frequently used for vegetation control within the perimeters of air bases during the Vietnam era.... While the Thailand CHECO Report does not report the use of tactical herbicides on allied bases in Thailand, it does indicate sporadic use of non tactical (commercial) herbicides within fenced perimeters. Therefore, if a veteran’s MOS (military occupational specialty) or unit is one that regularly had contact with the base perimeter there was a greater likelihood of exposure to commercial pesticides including herbicides. Security police units were known to have walked the perimeters, especially dog handlers. However, as noted above there are no records to show that the same tactical herbicides used in Vietnam were used in Thailand... If the veteran s claim is based on servicing or working on aircraft that flew bombing missions over Vietnam, please be advised that there is no presumption of ‘secondary’ exposure based on being near or working on aircraft that flew over Vietnam or handling equipment once used in Vietnam. Aerial spraying of tactical herbicides in Vietnam did not occur everywhere and it is inaccurate to think that herbicides covered every aircraft and piece of equipment associated with Vietnam. Additionally the high altitude jet aircraft stationed in Thailand generally flew far above the low and slow flying UC 123 aircraft that sprayed tactical herbicides over Vietnam during Operation RANCH HAND. Also there are no studies that we are aware of showing harmful health effects for any such secondary or remote herbicide contact that may have occurred... If the veteran’s claim is based on general herbicide use within the base, such as small scale brush or weed clearing activity along the flight line or around living quarters, there are no records of such activity involving tactical herbicides only the commercial herbicides... Based on the manual and supporting material it is generally presumed that herbicide was hand sprayed around the perimeter of identified bases in Thailand during certain periods of the Vietnam War era. See 38 C.F.R. § 19.5. VA has not extended the same special consideration to all service members who had contact with a Thai base perimeter. Those with periodic or occasional contact with the perimeter, but whose duty stations were not located there, are not entitled to special consideration. Therefore, the evidence must show that the Veteran’s duties placed him on or near the base perimeter for a significant period of time. The list of diseases associated with exposure to certain herbicide agents is as follows: AL amyloidosis, chloracne or other acneform disease consistent with chloracne, type 2 diabetes (also known as Type II diabetes mellitus or adult-onset diabetes), Hodgkin’s disease, ischemic heart disease (including, but not limited to, acute, subacute, and old myocardial infarction; atherosclerotic cardiovascular disease including coronary artery disease (including coronary spasm) and coronary bypass surgery; and stable, unstable and Prinzmetal’s angina), 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 C.F.R. § 3.309(e). For purposes of applying the herbicide presumption, “service in Vietnam” includes service in the waters offshore or service in other locations if the conditions of service involved duty or visitation to Vietnam from January 9, 1962, to May 7, 1975. 38 U.S.C. § 1116(a)(3); 38 C.F.R. §§ 3.307(a)(6)(iii); 3.313(a). The availability of presumptive service connection for a disability based on exposure to herbicides does not preclude a Veteran from establishing service connection with proof of direct causation. Stefl v. Nicholson, 21 Vet. App. 120 (2007); see also Combee v. Brown, 34 F.3d 1039 (Fed. Cir. 1994). Regulations also provide that a grant of service connection for PTSD requires the following: (i) if the evidence establishes a diagnosis of PTSD during service and the claimed stressor is related to that service, in the absence of clear and convincing evidence to the contrary, and provided that the claimed stressor is consistent with the circumstances, conditions, or hardships of the Veteran’s service, the Veteran’s lay testimony alone may establish the occurrence of the claimed in-service stressor; (ii) medical evidence diagnosing PTSD in accordance with 38 C.F.R. § 4.125(a); (iii) medical evidence establishing a link between current symptoms and an in-service stressor; and (iv) credible supporting evidence that the claimed in-service stressor occurred. 38 C.F.R. § 3.304(f). Effective July 13, 2010, if a stressor claimed by a veteran is related to that veteran’s fear of hostile military or terrorist activity and a VA psychiatrist or psychologist, or a psychiatrist or psychologist with whom VA has contracted, confirms that the claimed stressor is adequate to support a diagnosis of PTSD and that a veteran’s symptoms are related to the claimed stressor, in the absence of clear and convincing evidence to the contrary, and provided the claimed stressor is consistent with the places, types, and circumstances of that veteran’s service, a veteran’s lay testimony alone may establish the occurrence of the claimed in-service stressor. “[F]ear of hostile military or terrorist activity” means that a veteran experienced, witnessed, or was confronted with an event or circumstance that involved actual or threatened death or serious injury, or a threat to the physical integrity of the veteran or others, such as from an actual or potential improvised explosive device; vehicle-imbedded explosive device; incoming artillery, rocket, or mortar fire; grenade; small arms fire, including suspected sniper fire; or attack upon friendly military aircraft, and the veteran’s response to the event or circumstance involved a psychological or psycho-physiological state of fear, helplessness, or horror. See 75 Fed. Reg. 39,843 (Jul. 13, 2010) (codified at 38 C.F.R. § 3.304(f)(3)). Service connection may also be established on a secondary basis for a disability proximately due to or aggravated by a service-connected disease or injury. See 38 C.F.R. § 3.310; see also Allen v. Brown, 7 Vet. App. 439 (1995) (en banc). To establish secondary service connection, a Veteran must show: (1) the existence of a present disability; (2) the existence of a service-connected disability; and (3) a causal relationship between the present disability and the service-connected disability. See Wallin v. West, 11 Vet. App. 509, 512 (1998). The requirement of a current disability is “satisfied when a claimant has a disability at the time a claim for VA disability compensation is filed or during the pendency of that claim.” See McClain v. Nicholson, 21 Vet. App. 319, 321 (2007). c. Is the Veteran entitled to the presumption of herbicide exposure due to his service in Thailand and his alleged service in the Republic of Vietnam? i. Republic of Vietnam Service The widow claims, in substance, that the Veteran during his lifetime told her that he traveled from Thailand to Vietnam on TDY from October 1966 to November 1967 because during that time he served on aircraft that delivered supplies to troops in the Republic of Vietnam and he had to get off the aircraft to unload the supplies. Moreover, in a May 2005 statement the Veteran during his life time reported that he was involved in shuttle flights between bases in Vietnam and Thailand. However, the Veteran’s service personnel records do not document his ever having served in the Republic of Vietnam. Moreover, the Board is bound by the service department findings. See 38 C.F.R. § 3.203(a); Spencer v. West, 13 Vet. App. 376, 380 (2000) (VA is bound by service department findings); Duro v. Derwinski, 2 Vet. App. 530, 532 (1992) (“service department findings are binding on VA for purposes of establishing service in the U.S. Armed Forces”). Therefore, the Board finds that the most probative evidence of record are the service department records which shows that the Veteran did not ever step foot in the Republic of Vietnam. Accordingly, notwithstanding the widows claims to the contrary, the Board finds that the Veteran did not step foot in the Republic of Vietnam and the herbicide presumptions do not apply to her appeal. See 38 U.S.C. § 1116; 38 C.F.R. §§ 3.307, 3.309. ii. Thailand Service In the alternative the widow claims, in substance, that the Veteran was exposed to herbicides while serving in Thailand from September 1966 to November 1967. Moreover, as noted above, herbicide exposure will be conceded for veterans who served with the United States Air Force in a position which required duty on the air base perimeter (to include security police, dog handlers, etc.). Exposure will also be conceded for any United States Army veteran who served with a military police (MP) unit, or with a military police occupational specialty, on the Royal Thai Air Force Bases in U-Tapao, Ubon, Nakhon Phanom, Udorn, Takhli, Korat, or Don Muang. However, while the Veteran’s personnel file shows that he was stationed in Thailand, they also show that his occupational specialty was as administrative specialist and a postal specialist. The Board finds that neither of these positions are jobs that would have placed of the Veteran the perimeter of an Air Force base and exposed him to herbicide agents. Furthermore, the Board notes that the record is negative for any service department records that show that tactical herbicides were used, transported, or stored in and around where the Veteran was stationed in Thailand. Lastly, the Board notes that the appellant has not provided VA with any evidence beyond her own lay statements to support her claims that the Veteran was exposed to herbicides in Thailand. Therefore, the Board also finds that the most probative evidence of record shows that the Veteran did not have the type of job or posting while serving in Thailand that DoD envisioned would entail herbicide exposure. Accordingly, notwithstanding the widows claims to the contrary, the Board finds that the Veteran was not exposure to herbicides while serving in Thailand and the herbicide presumptions do not apply to her appeal. See 38 U.S.C. § 1116; 38 C.F.R. §§ 3.307, 3.309. d. Did the Veteran otherwise have actual herbicide exposure? As to proof of actual herbicide exposure, the appellant claims the Veteran was exposure to Agent Orange while on active duty. However, his service personnel records show he served in Thailand and, as discussed above, the most probative evidence of record shows that he was not exposed to tactical herbicides during this service. Moreover, the Board finds that the claimant’s writings to VA may not be accepted as verification of the Veteran having served where tactical herbicides were ever used, transported, or stored. As noted above, the Board is bound by service department findings and these records show that, while he served in Thailand, they are negative for evidence that his service ever included exposure to tactical herbicides including while an administrative specialist and a postal specialist in Thailand. See 38 C.F.R. § 3.203(a); Spencer, supra; Duro, supra. Therefore, the Board finds that the preponderance of the evidence is against the claim by the appellant that the Veteran he had actual exposure to tactical herbicide agents while on active duty. See Owens, supra. e. Does the Veteran have a diagnosis of PTSD due to an in-service stressor? In this regard, a review of the record on appeal reveals a May 2005 PTSD stressor statement from the Veteran in which he reported that he had PTSD due to the following stressors: (i) having a child hood friend killed in the Republic of Vietnam; (ii) having an aircraft he was flying in come under fire while traveling to the Republic of Vietnam; and (iii) being in a motor vehicle accident while on active duty. Moreover, the Board notes the VetCenter treatment records show the Veteran being diagnosed with PTSD due to his combat in the Republic of Vietnam. See VetCenter treatment record dated in May 2005 and June 2005. In this regard, the Board must note that the record does not support a finding that the Veteran was ever in combat in Vietnam. His occupational specialty was as administrative specialist and a postal specialist. There is significant evidence against this claim. His own statements to VA would not support such a finding. The record contains a casualty record that list the name of a Marine killed in action in the Republic of Vietnam. However, as noted above, service personnel records do not ever show that the Veteran served in the Republic of Vietnam. Likewise, the Board finds that service personnel records are negative for any evidence that the Veteran ever served in “combat”. Moreover, the Board finds that nothing in the Veteran’s service personnel records shows his being stationed in a location where it would be reasonable to conclude that he was in fear of hostile military or terrorist activity. Furthermore, the Veteran service records are negative for the claimed aircraft attack or motor vehicle accident. The Veteran’s own statement to the VA would provide evidence against this claim. As noted above, the Board is bound by the service department findings. See 38 C.F.R. § 3.203(a); Spencer, supra; Duro, supra. Moreover, to prevail on a claim of service connection for PTSD the record needs to show, among other things, a diagnosis of PTSD due to combat or fear of hostile military or terrorist activity or a verified stressor. See 38 C.F.R. § 3.304. In this regard, without the Veteran having verified service in the Republic of Vietnam neither the death of his friend in the Republic of Vietnam or the attack on his airplane are valid stressors. Similarly, without supporting service department records, the Board finds that he did not have combat service or service that would reasonably cause fear of hostile military or terrorist activity. Likewise, without supporting service department records, the Board also finds that the motor vehicle accident cannot act a stressor. As to the motor vehicle accident, the Board also notes that record does not contain a medical opinion linking PTSD to this event even if it had been verified. Therefore, the Board finds that the most probative evidence of record shows that the Veteran did not have a diagnosis of PTSD due to an in-service stressor. See Owens, supra. Accordingly, the Board finds that the Veteran was not entitled to service connection for PTSD during his lifetime. 38 U.S.C. §§ 1101, 1110, 1116, 1131; 38 C.F.R. §§ 3.303, 3.304. f. Was the Veteran entitled to service connection on a direct or secondary basis for lung cancer, glioblastoma, and an acquired psychiatric disorder that his widow claims caused the smoking that caused his lung cancer? As to establishing service connection for a with lung cancer, glioblastoma, and another acquired psychiatric disorder based on proof of direct causation under 38 C.F.R. § 3.303 (see Stefl, supra), the post-service record shows the Veteran’s being diagnosed with lung cancer and glioblastoma in 2002 (see June 2008 private treatment record) as well as major depressive and anxiety disorders (see VetCenter treatment record dated in May 2005 and June 2005; Diaz U. Riaz, M.D., dated in November 2001). Moreover, the May 1986 separation examination noted that the Veteran had a mild pulmonary obstructive defect. Furthermore, during his lifetime the Veteran was competent to report on the events he experiences while on active duty as well as manifestations of his disabilities. See Davidson, supra. As to an in-service disease or injury other than herbicide exposure, service treatment records, including a June 1978 examinations and the May 1986 separation examination, are otherwise negative for complaints of symptoms and/or a diagnosis of with lung cancer, glioblastoma, and an acquired psychiatric disorder. Moreover, the June 1978 examiner reported that the lung, head and psychiatric examinations were normal. Similarly, the May 1986 examiner noted reported that the lung, head and psychiatric examinations were normal except for the above noted mild pulmonary obstructive defect. Given the fact that a “mild pulmonary obstructive defect” is not the same as “lung cancer”, the Board also finds that the most probative evidence of record shows that the Veteran did not develop any of the claimed disorders while on active duty. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303(a); Colvin v. Derwinski, 1 Vet. App. 171, 175 (1991) (VA may only consider independent medical evidence to support its findings and is not permitted to base decisions on its own unsubstantiated medical conclusions); Owens, supra. The detailed records in service provide particularly negative evidence against the claims, clearly indicating treatment for problems other than the issue before the Board. Next, the Board notes that none of the claimed disabilities manifest in the first year following the Veteran’s separation from service. Therefore, the Board finds that the presumptions found at 38 C.F.R. § 3.309(a) do not apply to the current appeal. Similarly, the Board finds that the record does not show the Veteran had a continued problem with lung cancer, glioblastoma, and an acquired psychiatric disorder other than PTSD or PTSD in and since service. In fact, as noted above, the service treatment records, including the June 1978 and May 1986 examinations, are negative for complaints of symptoms and/or a diagnosis of with lung cancer, glioblastoma, and an acquired psychiatric disorder; providing highly probative evidence against the claim. Likewise, and more important than the above, the post-service record is negative for complaints, diagnoses, or treatment for lung cancer, glioblastoma, and an acquired psychiatric disorder until over a decade after service. See private treatment records dated in 2002. In this regard, the Board notes that a post-service chest x-ray dated in April 1994 was normal. Therefore, the Board finds that the most probative evidence of record shows that the Veteran did not have a continued problem with lung cancer, glioblastoma, and an acquired psychiatric disorder other than PTSD in and since service. See 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303(b). The Board finds that the post-service treatment records, which documents the Veteran’s complaints, diagnoses, or treatment for many other problems; provides highly evidence against the current claims. Furthermore, the Board finds that the most probative evidence of record shows that the Veteran’s post-service lung cancer, glioblastoma, and acquired psychiatric disorder other than PTSD are not due to his military service. See 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303(d); also see Rabideau v. Derwinski, 2 Vet. App. 141, 143 (1992) (establishing service connection requires finding a relationship between a current disability and events in service or an injury or disease incurred therein). As to the claim of service connection for lung cancer the Board notes that, while in April 2005 a VA examiner opined that the Veteran’s lung cancer was related to the in-service pulmonary function defect, in his subsequent July 2005 addendum the same examiner opined that the Veteran’s small cell lung cancer was not caused by or as a result of his mild pulmonary obstructive defect. The VA examiner noted that the Veteran separated from active duty in 1986 and developed cancer in 2002 with a long history of smoking cigarettes, putting him at a high risk for lung cancer. Similarly, as to the claims of service connection for lung cancer and glioblastoma, the October 2019 VA examiner opined that these disorders are not due to his military service including any alleged herbicide exposure. As to the lung cancer, it was also opined that it was due to the Veteran’s long history of smoking and as to the glioblastoma it was opined that it was caused by the radiation treatment for his lung cancer. The Board finds these opinions the most probative evidence of record because they were provided after a review of the record on appeal as well as because they are supported by ciation to evidence found in the record and not contradicted by any other medical evidence of record. See Owens, supra; Colvin, supra. The Board cannot ignore the facts of this case, including the long history of smoking, lung cancer that has been indicated to have been caused by his smoking, and radiation treatment of the lung cancer that has been indicated to have caused the Veteran’s glioblastoma, leading to his death. The post-service private treatment records (not simply the VA medical opinions, which also provide evidence against this case) provide particularly negative evidence against this case that the Board cannot ignore. As to his claim of service connection for an acquired psychiatric disorder other than PTSD, the Board finds that the criteria to obtain a etiology opinion have not been met because the record does not document his complaints, diagnoses, or treatment for this disorder during service or for over a decade after service. See Duenas v. Principi, 18 Vet. App. 512, 519 (2004) (VA is not obligated to provide an examination for a medical nexus opinion where, as here, the supporting evidence of record consists only of a lay statement). In addition, the Board finds that neither the Veteran during his lifetime or his wife at the current time are competent to provide the missing nexus opinions because they do not have the required medical expertise to provide answers to these complex medical questions (i.e., what caused the Veteran’s post-service lung cancer, glioblastoma, and acquired psychiatric disorder). See Davidson, supra. Lastly, the Board finds that the record does not show that secondary service connection is warranted for the glioblastoma that was caused by the radiation treatment for the lung cancer or for the lung cancer which the widow claims was caused by an acquired psychiatric disorder other than PTSD because, as explained above, the Veteran did not meet the criteria for service connection for lung cancer or an acquired psychiatric disorder. See 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.310; also see Allen, supra. Accordingly, the Board finds that the preponderance of the evidence is against the appellant’s claims that during his lifetime the Veteran was entitled to service connection for lung cancer, glioblastoma, and an acquired psychiatric disorder other than PTSD. 38 U.S.C. §§ 1101, 1110, 1112, 1113, 1116, 1131; 38 C.F.R. §§ 3.303,3.307, 3.309, 3.310. Conclusion Therefore, because the most probative evidence shows that an already service-connected disability did not cause or contributed substantially or materially to death and because service connection is not warranted for lung cancer, and glioblastoma as well as for an acquired psychiatric disorder including PTSD and a depressive disorder that the widow claims caused the Veteran to smoke, the Board finds that the preponderance of the evidence is against the appellant’s claim of service connection for the cause of the Veteran’s death. 38 U.S.C. § 1310; 38 C.F.R. § 3.312. There is now significant evidence against all claims in this case, supported by both private records and VA medical opinions, and the significant efforts to confirm the Veteran’s locations during his military service. In reaching all the above conclusions, the Board also considered the doctrine of reasonable doubt. 38 U.S.C. § 5107(b). However, as the preponderance of the evidence is against the claim, the doctrine is not for application. See also, e.g., Ortiz v. Principi, 274 F. 3d 1361 (Fed. Cir. 2001); Gilbert, supra. John J. Crowley Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board N.T. Werner, 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.